TY - JOUR
T1 - Prospective multi-institutional study of reverse transcriptase polymerase chain reaction for molecular staging of melanoma
AU - Scoggins, Charles R.
AU - Ross, Merrick I.
AU - Reintgen, Douglas S.
AU - Noyes, R. Dirk
AU - Goydos, James S.
AU - Beitsch, Peter D.
AU - Urist, Marshall M.
AU - Ariyan, Stephan
AU - Davidson, B. Scott
AU - Sussman, Jeffrey J.
AU - Edwards, Michael J.
AU - Martin, Robert C.G.
AU - Lewis, Angela M.
AU - Stromberg, Arnold J.
AU - Conrad, Andrew J.
AU - Hagendoorn, Lee
AU - Albrecht, Jeffrey
AU - McMasters, Kelly M.
PY - 2006/6/20
Y1 - 2006/6/20
N2 - Purpose: To evaluate the prognostic significance of molecular staging using reverse transcriptase polymerase chain reaction (RT-PCR) in detecting occult melanoma cells in sentinel lymph nodes (SLNs) and circulating bloodstream. Patients and Methods: In this multicenter study, eligibility criteria included patient age 18 to 71 years, invasive melanoma ≥ 1.0 mm Breslow thickness, and no clinical evidence of metastasis. SLN biopsy and wide excision of the primary tumor were performed. SLNs were examined by serial-section histopathology and S-100 immunohistochemistry. A portion of each SLN was frozen for RT-PCR. In addition, RT-PCR was performed on peripheral-blood mononuclear cells (PBMCs). RT-PCR analysis was performed using four markers: tyrosinase, MART1, MAGE3, and GP-100. Disease-free survival (DFS), distant-DFS (DDFS), and overall survival (OS) were analyzed. Results: A total of 1,446 patients with histologically negative SLNs underwent RT-PCR analysis. At a median follow-up of 30 months, there was no difference in DFS, DDFS, or OS between the RT-PCR-positive (n = 620) and RT-PCR-negative (n = 826) patients. Analysis of PBMC from 820 patients revealed significant differences in DFS and DDFS, but not OS, for patients with detection of more than one RT-PCR marker in peripheral blood. Conclusion: In this large, prospective, multi-institutional study, RT-PCR analysis on SLNs and PBMCs provides no additional prognostic information beyond standard histopathologic analysis of SLNs. Detection of more than one marker in PBMC is associated with a worse prognosis. RT-PCR remains investigational and should not be used to direct adjuvant therapy at this time.
AB - Purpose: To evaluate the prognostic significance of molecular staging using reverse transcriptase polymerase chain reaction (RT-PCR) in detecting occult melanoma cells in sentinel lymph nodes (SLNs) and circulating bloodstream. Patients and Methods: In this multicenter study, eligibility criteria included patient age 18 to 71 years, invasive melanoma ≥ 1.0 mm Breslow thickness, and no clinical evidence of metastasis. SLN biopsy and wide excision of the primary tumor were performed. SLNs were examined by serial-section histopathology and S-100 immunohistochemistry. A portion of each SLN was frozen for RT-PCR. In addition, RT-PCR was performed on peripheral-blood mononuclear cells (PBMCs). RT-PCR analysis was performed using four markers: tyrosinase, MART1, MAGE3, and GP-100. Disease-free survival (DFS), distant-DFS (DDFS), and overall survival (OS) were analyzed. Results: A total of 1,446 patients with histologically negative SLNs underwent RT-PCR analysis. At a median follow-up of 30 months, there was no difference in DFS, DDFS, or OS between the RT-PCR-positive (n = 620) and RT-PCR-negative (n = 826) patients. Analysis of PBMC from 820 patients revealed significant differences in DFS and DDFS, but not OS, for patients with detection of more than one RT-PCR marker in peripheral blood. Conclusion: In this large, prospective, multi-institutional study, RT-PCR analysis on SLNs and PBMCs provides no additional prognostic information beyond standard histopathologic analysis of SLNs. Detection of more than one marker in PBMC is associated with a worse prognosis. RT-PCR remains investigational and should not be used to direct adjuvant therapy at this time.
UR - http://www.scopus.com/inward/record.url?scp=33745548124&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33745548124&partnerID=8YFLogxK
U2 - 10.1200/JCO.2005.03.2342
DO - 10.1200/JCO.2005.03.2342
M3 - Article
C2 - 16782924
AN - SCOPUS:33745548124
VL - 24
SP - 2849
EP - 2857
IS - 18
ER -