Value of DNA ploidy and S-phase fraction as prognostic factors in stage III cutaneous melanoma.
OBJECTIVE
To determine the prognostic value of flow cytometric analysis (S-phase fraction and DNA index) performed on lymph-node metastases of patients with stage III melanoma.


METHODS
A retrospective chart review with flow cytometric analysis of paraffin-embedded tissues.


METHODS
A university teaching hospital.


METHODS
Among 332 patients with cutaneous melanoma, 33 with stage III were identified. Distant metastases developed in 16 patients; 17 had no further recurrence. Charts were reviewed to obtain clinicopathologic parameters such as sex, age, location of the primary tumour, histologic features, presence or absence of ulceration, and Clark's and Breslow's levels.


METHODS
DNA ploidy and S-phase fraction were determined on the paraffin-embedded nodes.


METHODS
The groups with or without recurrence were compared in terms of disease-free survival (DFS) and overall survival (OS). These survival parameters were correlated with DNA ploidy and S-phase fraction.


RESULTS
By univariate analysis, clinicopathologic factors did not predict OS. A higher Clark's level of invasion and more than 3 positive lymph nodes were associated with shorter DFS (p < 0.05). Tumour thickness and S-phase fraction did not correlate with either DFS or OS. Patients with diploid lymph-node metastases had an 87% 12-month survival compared with 41% for those with aneuploid tumours.


CONCLUSIONS
DNA ploidy may be used as a prognostic index in patients with lymph-node metastases. This could be particularly useful in the context of sentinel lymph-node mapping by which more patients are being identified with single microscopic lymph-node involvement.
Martin
G
G
Department of Surgical Oncology, Royal Victoria Hospital, McGill University, Montreal, Que.
Halwani
F
F
Shibata
H
H
Meterissian
S
S
D000704:Analysis of Variance; D004273:DNA, Neoplasm / Q000235:genetics*; D018572:Disease-Free Survival; D005260:Female; D005434:Flow Cytometry / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000145:classification / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods*; D011003:Ploidies; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D016196:S Phase / Q000235:genetics*; D012878:Skin Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology* / Q000628:therapy
D004273:DNA, Neoplasm