title: Prognostic factors in melanoma patients with tumor-negative sentinel lymph nodes.
abstract: BACKGROUND
  Sentinel lymph node (SLN) biopsy for melanoma results in accurate nodal staging, which guides treatment decisions. Patients with a negative SLN biopsy in general have a favorable prognosis, but certain subsets are at increased risk for recurrence and death. This study aimed to identify risk factors predictive of prognosis in patients with a tumor-negative SLN biopsy for cutaneous melanoma.
  
  
  METHODS
  In this post-hoc analysis of data from a multicenter prospective randomized trial, clinicopathologic data of patients with cutaneous melanoma ≥1.0 mm Breslow thickness and tumor-negative SLN were analyzed. Disease-free survival, overall survival (OS), and local and in-transit recurrence-free survival were compared by Kaplan-Meier analysis. Risk factors for worse survival were identified with Cox proportional hazard models.
  
  
  RESULTS
  This analysis included 1,998 patients with tumor-negative SLN with a median follow-up of 70 months. Ulceration, Breslow thickness, nonextremity tumor location, and age ≥45 years were independent risk factors for worse disease-free survival and OS. Breslow thickness and ulceration were the only factors on multivariate analysis that predicted local and in-transit recurrence-free survival. Estimated 5-year OS rates ranged from 55.5 to 95.4% on the basis of the defined risk factors.
  
  
  CONCLUSIONS
  There is a wide range of prognosis among patients with tumor-negative SLN. Breslow thickness, ulceration, age, and anatomic location of the primary melanoma are important independent factors predicting survival and recurrence among such patients. These factors can be used to stratify prognosis among patients with tumor-negative SLN to formulate rational long-term follow-up strategies as well as identify high-risk, SLN-negative patients for clinical trials of adjuvant therapy.
authors.affiliation: Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Egger
authors.affiliation: Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY.
authors.forename: Neal
authors.initials: N
authors.lastname: Bhutiani
authors.affiliation: Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY.
authors.forename: Russell W
authors.initials: RW
authors.lastname: Farmer
authors.affiliation: Department of Statistics, University of Kentucky, Lexington, KY.
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Stromberg
authors.affiliation: Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY.
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.affiliation: Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Quillo
authors.affiliation: Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.affiliation: Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY. Electronic address: charles.scoggins@louisville.edu.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology*; D016019:Survival Analysis