title: Regression does not predict nodal metastasis or survival in patients with cutaneous melanoma.
abstract: Controversy exists regarding the prognostic implications of regression in patients with cutaneous melanoma. Some consider regression to be an indication for sentinel lymph node (SLN) biopsy because regression may result in underestimation of the true Breslow thickness. Other data support  regression as a favorable prognostic indicator, representing immune system recognition of the primary tumor. This analysis was performed to determine whether regression predicts nodal metastasis, disease-free survival (DFS), or overall survival (OS). Post hoc analysis was performed of a multicenter  prospective randomized trial that included patients aged 18 to 70 years with cutaneous melanomas 1 mm or greater Breslow thickness. All patients underwent SLN biopsy; those with tumor-positive SLN underwent completion lymphadenectomy. Kaplan-Meier analysis of survival, univariate analysis,  and multivariate analysis were performed. A total of 2220 patients (261 with regression; 1959 without regression) were included in this analysis with a median follow-up of 68 months. Patients with regression were more likely to be male, older than 50 years old, and have lower median Breslow  thickness, superficial spreading histologic subtype, and a nonextremity anatomic location (P < 0.05 in all cases). Regression was not significantly associated with Clark level, ulceration, lymphovascular invasion, number of SLNs removed, or SLN metastasis. On multivariate analysis,  factors independently predictive of DFS included Breslow thickness, ulceration, and SLN status (P < 0.05 in all cases); the same factors along with age, gender, and anatomic tumor location were significantly associated with OS (P < 0.05 in all cases). Regression was not  significantly associated with DFS (risk ratio [RR], 0.94; 95% confidence interval [CI], 0.67-1.27; P = 0.68) or OS (RR, 1.01; 95% CI, 0.76-1.32; P = 0.93). These data suggest that regression is not a significant prognostic factor for patients with cutaneous melanoma  and should not be used to guide clinical decision-making for such patients.
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Kentucky, USA.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Burton
authors.forename: Juliana
authors.initials: J
authors.lastname: Gilbert
authors.forename: Russell W
authors.initials: RW
authors.lastname: Farmer
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Stromberg
authors.forename: Lee
authors.initials: L
authors.lastname: Hagendoorn
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.forename: Glenda G
authors.initials: GG
authors.lastname: Callender
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; 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; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D016019:Survival Analysis; D019564:Unnecessary Procedures; D055815:Young Adult