Comparison of sentinel lymph node micrometastatic tumor burden measurements in melanoma

Michael E. Egger, Matthew R. Bower, Irene A. Czyszczon, Hanan Farghaly, R. Dirk Noyes, Douglas S. Reintgen, Robert C.G. Martin, Charles R. Scoggins, Arnold J. Stromberg, Kelly M. McMasters

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Background Multiple methods have been proposed to classify the micrometastatic tumor burden in sentinel lymph nodes (SLN) for melanoma. The purpose of this study was to determine the classification scheme that best predicts nonsentinel node (NSN) metastasis, disease-free survival (DFS), and overall survival (OS). Study Design A single reviewer reanalyzed tumor-positive SLN from a multicenter, prospective clinical trial of patients with melanoma ≥1.0 mm Breslow thickness who underwent SLN biopsy. The following micrometastatic disease burden measurements were recorded: Starz classification, Dewar classification (microanatomic location), maximum diameter of the largest focus of metastasis, maximum tumor area, and sum of all diameters. Univariate and multivariate models and Kaplan-Meier analysis were used to evaluate each classification system. Results We reviewed 204 tumor-positive SLNs from 157 patients. On univariate analysis, all criteria except Starz classification were statistically significant risk factors for NSN metastasis. On multivariate analysis, including Breslow thickness, ulceration, age, sex, and NSN status, maximum diameter (using a cut-off of 3 mm) was the only classification system that was an independent risk factor predicting DFS (hazard ratio 2.31, p = 0.0181) and OS (hazard ratio 3.53, p = 0.0005). By Kaplan-Meier analysis, DFS and OS were significantly different among groups using maximum diameter cut-offs of 1 and 3 mm. Conclusions Maximum tumor diameter outperformed other measurements of metastatic tumor burden, including microanatomic tumor location (Dewar classification), Starz classification, maximum tumor area, and sum of all diameters for prediction of survival. Maximum tumor diameter is a simple method of assessing micrometastatic tumor burden that should be reported routinely.

Original languageEnglish
Pages (from-to)519-528
Number of pages10
JournalJournal of the American College of Surgeons
Issue number4
StatePublished - Apr 2014

Bibliographical note

Funding Information:
Disclosure Information: This is a review of data from the Sunbelt Melanoma Trial, which was an investigator-initiated clinical trial supported in part by a grant from Schering Oncology Biotech. All data management and subsequent analysis was performed independently at the University of Louisville. Schering Oncology Biotech was not directly involved in the conduct of the trial or in the production of this manuscript.

ASJC Scopus subject areas

  • Surgery


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