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Annals of Surgical Oncology
Erschienen in: Annals of Surgical Oncology 8/2006

01.08.2006

Factors Predicting the Risk of In-Transit Recurrence After Sentinel Lymphonodectomy in Patients With Cutaneous Malignant Melanoma

verfasst von: Lutz Kretschmer, MD, Iris Beckmann, MD, Kai-Martin Thoms, MD, Christina Mitteldorf, MD, Hans Peter Bertsch, MD, Christine Neumann, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 8/2006

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Abstract

Background

In-transit metastasis is an important morbidity factor after sentinel lymphonodectomy (SLNE). So far, factors posing an increased risk after SLNE have not been adequately analyzed.

Methods

Using Kaplan-Meier estimations and the Cox proportional hazards model, we analyzed the risk of developing in-transit metastases after SLNE for 328 consecutive patients (median tumor thickness, 2.0 mm; median follow-up period, 40 months).

Results

The 5-year probability of developing in-transit metastases as a first recurrence was 11.2%. After negative and positive SLNE, the probabilities were 6.3% and 24%, respectively. Patients in whom satellite metastases were excised concurrently with the primary tumor had a probability of recurrence with in-transit metastases of 41%. In sentinel lymph node (SLN)-negative patients with primary tumors having a thickness of more than 4 mm, the probability was 22.1%. Among the group of SLN-positive patients, significantly increased in-transit probabilities were observed in those with primary tumors that were thicker than 4 mm (41.8%), with tumors located on the distal extremities (42.1%), and with penetration of the nodal metastasis of >1 mm into the SLN (36%) and in patients with capsular breakthrough (63.3%). By using multifactorial analysis, the SLN status (P = .005), Breslow thickness (P = .0009), and extremity location of the primary melanoma (P = .005) significantly predicted the risk of in-transit recurrence. Satellite metastasis (P < .089), Clark level, and ulceration did not reach significance.

Conclusions

Subgroups of patients can be identified who seem to have an increased risk of developing in-transit metastases as a first recurrence after SLNE. Individualized therapeutic strategies should be developed for these patients.
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Metadaten
Titel
Factors Predicting the Risk of In-Transit Recurrence After Sentinel Lymphonodectomy in Patients With Cutaneous Malignant Melanoma
verfasst von
Lutz Kretschmer, MD
Iris Beckmann, MD
Kai-Martin Thoms, MD
Christina Mitteldorf, MD
Hans Peter Bertsch, MD
Christine Neumann, MD
Publikationsdatum
01.08.2006
Erschienen in
Annals of Surgical Oncology / Ausgabe 8/2006
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/ASO.2006.07.020

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