title: Predictors of sentinel lymph node status in cutaneous melanoma: a classification and regression tree analysis.
abstract: OBJECTIVE
  The main aim of this study was to identify predictors of sentinel lymph node (SN) metastasis in cutaneous melanoma.
  
  
  METHODS
  This was a retrospective cohort study of 818 patients in 2 tertiary-level hospitals. The primary outcome variable was SN involvement. Independent predictors were identified using multiple logistic regression and a classification and regression tree (CART) analysis.
  
  
  RESULTS
  Ulceration, tumor thickness, and a high mitotic rate (≥6 mitoses/mm(2)) were independently associated with SN metastasis in the multiple regression analysis. The most important predictor in the CART analysis was Breslow thickness. Absence of an inflammatory infiltrate, patient age, and tumor location were predictive of SN metastasis in patients with tumors thicker than 2mm. In the case of thinner melanomas, the predictors were mitotic rate (>6 mitoses/mm(2)), presence of ulceration, and tumor thickness. Patient age, mitotic rate, and tumor thickness and location were predictive of survival.
  
  
  CONCLUSIONS
  A high mitotic rate predicts a higher risk of SN involvement and worse survival. CART analysis improves the prediction of regional metastasis, resulting in better clinical management of melanoma patients. It may also help select suitable candidates for inclusion in clinical trials.
authors.affiliation: Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga, España. Electronic address: antoniotejera@aedv.es.
authors.forename: A
authors.initials: A
authors.lastname: Tejera-Vaquerizo
authors.affiliation: Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga, España.
authors.forename: P
authors.initials: P
authors.lastname: Martín-Cuevas
authors.affiliation: Servicio de Anatomía Patológica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga, España.
authors.forename: E
authors.initials: E
authors.lastname: Gallego
authors.affiliation: Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga, España.
authors.forename: E
authors.initials: E
authors.lastname: Herrera-Acosta
authors.affiliation: Departamento de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España.
authors.forename: V
authors.initials: V
authors.lastname: Traves
authors.affiliation: Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga, España.
authors.forename: E
authors.initials: E
authors.lastname: Herrera-Ceballos
authors.affiliation: Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia. España.
authors.forename: E
authors.initials: E
authors.lastname: Nagore
mesh_terms: D000367:Age Factors; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D016246:Lymphocytes, Tumor-Infiltrating / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000145:classification / Q000556:secondary*; D008875:Middle Aged; D008940:Mitotic Index; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*; D012883:Skin Ulcer / Q000209:etiology; D062606:Tertiary Care Centers
keywords: Biopsia de ganglio linfático centinela; Linfocitos que infiltran los tumores; Melanoma; Mitotic index; Prognosis; Pronóstico; Sentinel lymph node biopsy; Tumor infiltrating lymphocytes; Índice mitótico