title: Prognostic significance of molecular upstaging of paraffin-embedded sentinel lymph nodes in melanoma patients.
abstract: OBJECTIVE
  Detection of micrometastases in sentinel lymph nodes (SLNs) is important for accurate staging and prognosis in melanoma patients. However, a significant number of patients with histopathology-negative SLNs subsequently develop recurrent disease. We hypothesized that a quantitative realtime reverse transcriptase polymerase chain reaction (qRT) assay using multiple specific mRNA markers could detect occult metastasis in paraffin-embedded (PE) SLNs to upstage and predict disease outcome.
  
  
  METHODS
  qRT was performed on retrospectively collected PE SLNs from 215 clinically node-negative patients who underwent lymphatic mapping and sentinel lymphadenectomy for melanoma and were followed up for at least 8 years. PE SLNs (n = 308) from these patients were sectioned and assessed by qRT for mRNA of four melanoma-associated genes: MART-1 (antigen recognized by T cells-1), MAGE-A3 (melanoma antigen gene-A3 family), GalNAc-T (beta1-->4-N-acetylgalactosaminyl-transferase), and Pax3 (paired-box homeotic gene transcription factor 3).
  
  
  RESULTS
  Fifty-three (25%) patients had histopathology-positive SLNs by hemotoxylin and eosin and/or immunohistochemistry. Of the 162 patients with histopathology-negative SLNs, 48 (30%) had nodes that expressed at least one of the four qRT markers, and these 48 patients also had a significantly increased risk of disease recurrence by a Cox proportional hazards model analysis (P <.0001; risk ratio, 7.48; 95% CI, 3.70 to 15.15). The presence of > or = one marker in histopathology-negative SLNs was also a significant independent prognostic factor by multivariate analysis for overall survival (P =.0002; risk ratio, 11.42; 95% CI, 3.17 to 41.1).
  
  
  CONCLUSIONS
  Molecular upstaging of PE histopathology-negative SLNs by multiple-marker qRT assay is a significant independent prognostic factor for long-term disease recurrence and overall survival of patients with early-stage melanoma.
authors.affiliation: Department of Molecular Oncology, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA 90404, USA.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Donald L
authors.initials: DL
authors.lastname: Morton
authors.forename: Christine
authors.initials: C
authors.lastname: Kuo
authors.forename: Roderick R
authors.initials: RR
authors.lastname: Turner
authors.forename: David
authors.initials: D
authors.lastname: Elashoff
authors.forename: Robert
authors.initials: R
authors.lastname: Elashoff
authors.forename: Bret
authors.initials: B
authors.lastname: Taback
authors.forename: Akihide
authors.initials: A
authors.lastname: Fujimoto
authors.forename: Dave S B
authors.initials: DS
authors.lastname: Hoon
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005819:Genetic Markers; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008545:Melanoma / Q000235:genetics* / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012333:RNA, Messenger / Q000032:analysis; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000235:genetics* / Q000473:pathology*; D013048:Specimen Handling
chemical_list: D005819:Genetic Markers; D012333:RNA, Messenger