title: Prognostic significance of microscopic tumor burden in sentinel lymph node in patients with cutaneous melanoma.
abstract: OBJECTIVE
  Sentinel lymph node (SLN) biopsy provides useful prognostic information for patients with melanoma. The present study sought to determine the prognostic value of SLN tumor burden on overall survival (OS) and disease-free survival (DFS). We also assessed its association with non-sentinel lympth node (NSLN) involvement.
  
  
  METHODS
  We conducted a retrospective review of 138 patients with cutaneous melanoma, who were found to have positive SLNs from 2000 to 2011. SLN tumor burden was measured in the maximum diameter of the largest tumor focus. OS and DFS were assessed by the Kaplan-Meier method and Cox proportional hazard regression model. A logistic regression model was used to evaluate the association between SLN tumor burden and NSLN positivity.
  
  
  RESULTS
  On multivariable analysis, SLN tumor burden was significantly associated with OS (hazard ratio (HR)>1 vs. ≤ 1 mm=5.15; 95% confidence interval (CI)=2.32-11.44; p<0.0001) and DFS rate (HR>1 vs. ≤ 1 mm=3.02; 95% CI=1.37-6.67; p=0.0064). On univariate analysis, SLN tumor burden was significantly associated with NSLN positivity (OR>1 vs. ≤ 1 mm=3.41; 95% CI=1.03-11.27; p=0.04).
  
  
  CONCLUSIONS
  SLN tumor burden, by measuring the maximum diameter of the largest tumor focus, is significantly associated with OS, DFS and NSLN involvement.
authors.affiliation: Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, U.S.A.
authors.forename: Chul
authors.initials: C
authors.lastname: Kim
authors.affiliation: Plastic Surgery Consultants, Edina, MN, U.S.A.
authors.forename: Sam
authors.initials: S
authors.lastname: Economou
authors.affiliation: Minnesota Oncology, Fridley, MN, U.S.A.
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Amatruda
authors.affiliation: Hospital Pathology Associates, Minneapolis, MN, U.S.A.
authors.forename: Jena C
authors.initials: JC
authors.lastname: Martin
authors.affiliation: University of Illinois at Chicago, Chicago, IL, U.S.A. adudek@uic.edu.
authors.forename: Arkadiusz Z
authors.initials: AZ
authors.lastname: Dudek
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary*; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D047368:Tumor Burden
keywords: Sentinel lymph node; melanoma; tumor burden