title: Outcome of clinical stage III melanoma patients with FDG-PET and whole-body CT added to the diagnostic workup.
abstract: BACKGROUND
  Combined whole-body FDG-PET and CT provide the most comprehensive staging of melanoma patients with palpable lymph node metastases (LNM). The aim of this study is to analyze survival of FDG-PET and CT negative or positive melanoma patients and to assess which factors have independent prognostic impact on survival of these patients.
  
  
  METHODS
  Patients with palpable and histologically or cytologically proven LNM of melanoma, referred to participating hospitals for examination with FDG-PET and CT, were selected from a previous study. Melanoma-specific survival (MSS) and disease-free period (DFP) were analyzed for FDG-PET and CT positive and negative patients using the Kaplan-Meier method. Cox-regression analysis was performed to analyze which patient or melanoma characteristics had significant impact on MSS or DFP.
  
  
  RESULTS
  For all 252 patients 5-year MSS was 38.2%. For FDG-PET and CT negative and positive patients 5-year MSS was 47.6 and 16.9%, respectively. Disease-free period for FDG-PET and CT negative patients was 46.0% after 5 years. Gender, a positive FDG-PET and CT, LNM in axilla compared to head or neck, and presence of extranodal growth were independent factors for worse MSS in all patients. Positive FDG-PET and CT was the most important prognostic factor for MSS with a hazard ratio of 2.54 (95% CI, 1.55-4.17, P<0.001).
  
  
  CONCLUSIONS
  Staging melanoma patients with palpable LNM is more accurate when whole-body FDG-PET and CT is added to the diagnostic workup. Hence, FDG-PET and CT, preferably combined, are indicated in the staging of clinical stage III melanoma patients.
authors.affiliation: Department of Surgical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: M G
authors.initials: MG
authors.lastname: Niebling
authors.forename: E
authors.initials: E
authors.lastname: Bastiaannet
authors.forename: O S
authors.initials: OS
authors.lastname: Hoekstra
authors.forename: J J
authors.initials: JJ
authors.lastname: Bonenkamp
authors.forename: R
authors.initials: R
authors.lastname: Koelemij
authors.forename: H J
authors.initials: HJ
authors.lastname: Hoekstra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000401:mortality*; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D012878:Skin Neoplasms; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18