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Erschienen in:
01.07.2015 | Melanomas
Lymph-Node Ratio in Patients with Cutaneous Melanoma: A Multi-Institution Prognostic Study
Erschienen in: Annals of Surgical Oncology | Ausgabe 7/2015
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Background
Lymph node ratio (LNR)—the number of metastatic lymph nodes (LNs) over the number of excised LNs after lymphadenectomy—is a prognostic factor for many solid tumors, but controversies still exist for skin melanoma. We investigated the prognostic relevance of LNR in melanoma patients and formulated a proposal for considering the LNR in the current American Joint Committee on Cancer (AJCC) N staging system.
Methods
Retrospective data of 2,526 melanoma patients with LN metastasis from nine Italian institutions were collected in a multicenter database. The prognostic value of the LNR (categorized as A, ≤0.1; B, 0.11–0.25; and C, >0.25) was assessed by multivariable survival analysis.
Results
LNR was a significant independent prognostic factor for melanoma-specific survival (LNR B vs. A: hazard ratio [HR] 1.47, 95 % CI 1.16–1.87, p = 0.002; LNR C vs. A: HR 1.84, 95 % CI 1.29–2.61, p = 0.001). The LNR had prognostic value in patients with AJCC N1a (one positive LN after sentinel LN biopsy [SLNB], HR 2.33, 95 % CI 1.49–3.63, p < 0.001) and N2a (two to three positive LNs after SLNB, HR 1.62, 95 % CI 1.09–2.40, p = 0.016) substages, but not in those with N1b (one clinically positive LN, p = 0.765), N2b (two to three clinically positive LNs, p = 0.165), and N3 (≥ four positive LNs, p = 0.084) substages.
Conclusion
The LNR is a prognostic factor in melanoma patients with one (AJCC N1a) and two to three (AJCC N2a) positive LNs after SLNB. This easy-to-obtain parameter should be considered for the staging of melanoma patients with LN metastasis, along with the number of positive LNs.