title: Prognostic importance of lymph node tumor burden in melanoma patients staged by sentinel node biopsy.
abstract: BACKGROUND
  The objective of this study was to investigate the relationship between nodal tumor burden and the outcomes of recurrence and survival in sentinel node-positive melanoma patients.
  
  
  METHODS
  We reviewed a series of sentinel node-positive patients with primary cutaneous melanoma treated with completion lymph node dissection (CLND). Microscopic nodal tumor deposits were counted and measured with an ocular micrometer. Various measures of tumor burden and traditional melanoma prognostic indicators were studied in multivariate Cox regression models.
  
  
  RESULTS
  Sentinel lymph node and CLND specimens were evaluated in 90 node-positive patients. The diameter of the largest lymph node tumor nodule and the total lymph node tumor volume were significant predictors of recurrence (two-sided P <.0001 for both) and survival (two-sided P =.0018 and P =.0002, respectively). A tumor deposit diameter of 3 mm was identified as the most significant cut point predictive of recurrence (P <.0001; hazard ratio, 5.18) and survival (P <.0001; hazard ratio, 5.43). The 3-year survival probability was.86 for patients with largest tumor deposit diameters of <or=3 mm and was .27 for patients with largest deposit diameters >3 mm (P <.0001).
  
  
  CONCLUSIONS
  Microstaging of melanoma sentinel lymph node/CLND specimens by using the diameter of the largest tumor deposit is a highly significant predictor of early relapse and survival.
authors.affiliation: Department of Surgery/Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indiana University-Purdue University, Indianapolis, Indiana, USA.
authors.forename: Jaime M
authors.initials: JM
authors.lastname: Ranieri
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Wagner
authors.forename: Rafael
authors.initials: R
authors.lastname: Azuaje
authors.forename: D
authors.initials: D
authors.lastname: Davidson
authors.forename: Stacie
authors.initials: S
authors.lastname: Wenck
authors.forename: Joanne
authors.initials: J
authors.lastname: Fyffe
authors.forename: John J
authors.initials: JJ
authors.lastname: Coleman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D018709:Statistics, Nonparametric; D015996:Survival Rate