Critical appraisal:Rossi CR, Mozzillo N, Maurichi A, Pasquali S, Quaglino P, Borgognoni L, et al 2014
Critical Appraisal
Rossi CR, Mozzillo N, Maurichi A, Pasquali S, Quaglino P, Borgognoni L, et al. The number of excised lymph nodes is associated with survival of melanoma patients with lymph node metastasis. Ann Oncol 2014 Jan;25(1):240-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24356635.
Key Facts
case series
To evaluate the association between the number of excised regional lymph nodes (LNs) and melanoma-specific survival.
2507
Prognostic factors
Survival
LNs influence on tumour staging
Multivariable regression analysis, later years of diagnosis (difference between median values: 3 LNs; P < 0.001), younger age (difference between median values: 2 LNs; P < 0.001), male sex (difference between median values: 2 LNs, P = 0.004), neck LN field (P < 0.001), micrometastasis (difference between median values: 1 LN; P < 0.001) and a greater number of positive LNs (P < 0.001) were associated with a greater number of excised LNs, groin LN field (P < 0.001) correlated with lesser excised LNs
At follow-up, 623 patients (25%) died for melanoma. Number of excised LNs= independent predictor of melanoma-specific survival after adjustment multivariable model including later year of diagnosis, older age, male sex, primary tumour showing greater thickness, ulceration and Clark level V, AJCC sub-stages N2 and N3.
Multivariable survival analysis conducted in subgroups. Number of excised LN: prognostic factor for intermediate thick primary, tumours showing ulceration and Clark level V, micrometastasis and 2 to 3 positive LNs.
Patients with ≤10 excised nodes (N = 208, 8.3%) were not adequately staged as showed by the crossing survival curves of the AJCC N-stage 1, 2 and 3 (test for trend, P = 0.406). remaining insignificant at multivariable analysis after adjusting for the other variables [AJCC N2 versus N1, HR = 1.62; 95% confidence interval (CI) 0.88–2.98, P = 0.118; AJCC N3 versus N1, HR = 0.82; 95% CI 0.33–2.04, P = 0.673]. ≥11 nodes yielded (2299, 91.7%), prognosis can be properly stratified (test for trend, P < 0.001). Prognostic significance remained at multivariable analysis after adjustment (AJCC N2 versus N1, HR = 1.26; 95% CI 1.02–1.56, P= 0.034; AJCC N3 versus N1, HR = 1.67; 95% CI 1.33–2.11, P < 0.001).
When less than 14, 11, 9 and 12 LNs were excised in the neck (P = 0.309), axilla (P = 0.957), inguinal (P = 0.880) and ilioinguinal (P = 0.404) lymphatic fields, respectively, the AJCC N substages did not have prognostic value. AJCC N substage stratified patient survival when at least 14, 11, 10 and 12 LNs were excised in the neck (P = 0.05), axilla (P < 0.001), inguinal (P = 0.027) and ilioinguinal (P < 0.001) lymphatic fields, respectively.
no
Evidence ratings
IV
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Included
This appraisal has been completed.
- Article
- Rossi CR, Mozzillo N, Maurichi A, Pasquali S, Quaglino P, Borgognoni L, et al. The number of excised lymph nodes is associated with survival of melanoma patients with lymph node metastasis. Ann Oncol 2014 Jan;25(1):240-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24356635.
- Assigned to
- User:Jackie.buck
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- Clinical question
Section below only relevant for Cancer Council Project Officer