title: Nonsentinel lymph node status in patients with cutaneous melanoma: results from a multi-institution prognostic study.
abstract: OBJECTIVE
  We investigated whether the nonsentinel lymph node (NSLN) status in patients with melanoma improves the prognostic accuracy of common staging features; then we formulated a proposal for including the NSLN status in the current melanoma staging system.
  
  
  METHODS
  We retrospectively collected the clinicopathologic data of 1,538 patients with positive SLN status who underwent completion lymph node dissection (CLND) at nine Italian centers. Multivariable Cox regression survival analysis was used to identify independent prognostic factors. Literature meta-analysis was used to summarize the available evidence on the prognostic value of the NSLN status in patients with positive SLN.
  
  
  RESULTS
  NSLN metastasis was observed in 353 patients (23%). After a median follow-up of 45 months, NSLN status was an independent prognostic factor for melanoma-specific survival (hazard ratio [HR] = 1.34; 95% CI, 1.18 to 1.52; P < .001). NSLN status efficiently stratified the prognosis of patients with two to three positive lymph nodes (n = 387; HR = 1.39; 95% CI, 1.07 to 1.81; P = .013), independently of other staging features. Searching the literature, this patient subgroup was investigated in other two studies. Pooling the results (n = 620 patients; 284 NSLN negative and 336 NSLN positive), we found that NSLN status is a highly significant prognostic factor (summary HR = 1.59; 95% CI, 1.27 to 1.98; P < .001) in patients with two to three positive lymph nodes.
  
  
  CONCLUSIONS
  These findings support the independent prognostic value of the NSLN status in patients with two to three positive lymph nodes, suggesting that this information should be considered for the routine staging in patients with melanoma.
authors: Sandro Pasquali, Simone Mocellin, and Carlo Riccardo Rossi, University of Padova; Carlo Riccardo Rossi, Veneto Institute of Oncology, Padova; Nicola Mozzillo and Corrado Caracò, National Cancer Institute "Pascale," Naples; Andrea Maurichi and Ugo Marone, National Cancer Institute; Luigi Mascheroni, San Pio X Hospital, Milan; Pietro Quaglino, Roberto Patuzzo, and Mario Santinami, University of Turin, Turin; Lorenzo Borgognoni, Tuscan Tumor Institute, Florence; Nicola Solari and Simone Ribero, National Cancer Research Institute of Genova, Genova; Dario Piazzalunga, Riuniti Hospital, Bergamo; and Giuseppe Giudice, University of Bari, Bari, Italy.
authors: Sandro
authors: S
authors: Pasquali
authors: Simone
authors: S
authors: Mocellin
authors: Nicola
authors: N
authors: Mozzillo
authors: Andrea
authors: A
authors: Maurichi
authors: Pietro
authors: P
authors: Quaglino
authors: Lorenzo
authors: L
authors: Borgognoni
authors: Nicola
authors: N
authors: Solari
authors: Dario
authors: D
authors: Piazzalunga
authors: Luigi
authors: L
authors: Mascheroni
authors: Giuseppe
authors: G
authors: Giudice
authors: Roberto
authors: R
authors: Patuzzo
authors: Corrado
authors: C
authors: Caracò
authors: Simone
authors: S
authors: Ribero
authors: Ugo
authors: U
authors: Marone
authors: Mario
authors: M
authors: Santinami
authors: Carlo Riccardo
authors: CR
authors: Rossi
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D000096142:Cutaneous Malignant Melanoma