title: Lymphovascular invasion as a prognostic factor in melanoma.
abstract: The prognostic significance of lymphovascular invasion (LVI) in melanoma remains controversial. Clinicopathologic data from a prospective trial of patients with melanoma were analyzed with respect to LVI. Disease-free survival and overall survival (OS) were evaluated by Kaplan-Meier  (KM) analysis. Univariate and multivariate analyses were performed to evaluate factors predictive of tumor-positive sentinel nodes (SLN) and survival. A total of 2183 patients were included in this analysis; 171 (7.8%) had LVI. Median follow-up was 68 months. Factors associated with LVI included  tumor thickness, ulceration, and histologic subtype (P < 0.05). LVI was associated with a greater risk of SLN metastasis (P < 0.05). By KM analysis, LVI was associated with worse OS (P = 0.0009). On multivariate analysis, age, gender, thickness, ulceration, anatomic  location, and SLN status were predictors of OS; however, LVI was not an independent predictor of OS. Among patients with regression, the 5-year OS rate was 49.4 per cent for patients with LVI versus 81.1 per cent for those with no LVI (P < 0.0001). LVI is associated with a  greater risk of SLN metastasis. Although LVI is not an independent predictor of OS in general, it is a powerful predictor of worse OS among patients who have evidence of regression of the primary tumor.
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Kentucky, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Egger
authors.forename: Julianna E
authors.initials: JE
authors.lastname: Gilbert
authors.forename: Alison L
authors.initials: AL
authors.lastname: Burton
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.forename: Glenda G
authors.initials: GG
authors.lastname: Callender
authors.forename: Amy R
authors.initials: AR
authors.lastname: Quillo
authors.forename: Russell E
authors.initials: RE
authors.lastname: Brown
authors.forename: Charles R
authors.initials: CR
authors.lastname: St Hill
authors.forename: Lee
authors.initials: L
authors.lastname: Hagendoorn
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Stromberg
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002423:Cause of Death; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D016019:Survival Analysis; D055815:Young Adult