Gene expression profiling for molecular staging of cutaneous melanoma in patients undergoing sentinel lymph node biopsy.
BACKGROUND
A gene expression profile (GEP) test able to accurately identify risk of metastasis for patients with cutaneous melanoma has been clinically validated.


OBJECTIVE
We aimed for assessment of the prognostic accuracy of GEP and sentinel lymph node biopsy (SLNB) tests, independently and in combination, in a multicenter cohort of 217 patients.


METHODS
Reverse transcription polymerase chain reaction (RT-PCR) was performed to assess the expression of 31 genes from primary melanoma tumors, and SLNB outcome was determined from clinical data. Prognostic accuracy of each test was determined using Kaplan-Meier and Cox regression analysis of disease-free, distant metastasis-free, and overall survivals.


RESULTS
GEP outcome was a more significant and better predictor of each end point in univariate and multivariate regression analysis, compared with SLNB (P < .0001 for all). In combination with SLNB, GEP improved prognostication. For patients with a GEP high-risk outcome and a negative SLNB result, Kaplan-Meier 5-year disease-free, distant metastasis-free, and overall survivals were 35%, 49%, and 54%, respectively.


CONCLUSIONS
Within the SLNB-negative cohort of patients, overall risk of metastatic events was higher (∼30%) than commonly found in the general population of patients with melanoma.


CONCLUSIONS
In this study cohort, GEP was an objective tool that accurately predicted metastatic risk in SLNB-eligible patients.
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: pgerami@nmff.org.
Pedram
P
Gerami
Castle Biosciences Inc, Friendswood, Texas.
Robert W
RW
Cook
Winship Cancer Institute of Emory University, Atlanta, Georgia.
Maria C
MC
Russell
St Joseph's Hospital and Medical Center, Phoenix, Arizona.
Jeff
J
Wilkinson
University of Texas MD Anderson Cancer Center, Houston, Texas.
Rodabe N
RN
Amaria
University of Colorado Denver, Denver, Colorado.
Rene
R
Gonzalez
University of Massachusetts Medical Center, Worcester, Massachusetts.
Stephen
S
Lyle
Kelsey-Seybold Clinic, Houston, Texas.
Gilchrist L
GL
Jackson
Kelsey Research Foundation, Houston, Texas.
Anthony J
AJ
Greisinger
Castle Biosciences Inc, Friendswood, Texas.
Clare E
CE
Johnson
Castle Biosciences Inc, Friendswood, Texas.
Kristen M
KM
Oelschlager
St Joseph's Hospital and Medical Center, Phoenix, Arizona.
John F
JF
Stone
Castle Biosciences Inc, Friendswood, Texas.
Derek J
DJ
Maetzold
Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Laura K
LK
Ferris
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Surgery-Surgical Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Jeffrey D
JD
Wayne
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Chelsea
C
Cooper
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Roxana
R
Obregon
Winship Cancer Institute of Emory University, Atlanta, Georgia.
Keith A
KA
Delman
Winship Cancer Institute of Emory University, Atlanta, Georgia.
David
D
Lawson
D018572:Disease-Free Survival; D020869:Gene Expression Profiling; D006801:Humans; D053208:Kaplan-Meier Estimate; D008545:Melanoma / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D012044:Regression Analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms; D000096142:Cutaneous Malignant Melanoma
cutaneous melanoma; gene expression profiling; metastasis; prognostic; sentinel lymph node biopsy; staging