title: Mitotic rate correlates with sentinel lymph node status and outcome in cutaneous melanoma greater than 1 millimeter in thickness: A multi-institutional study of 1524 cases.
abstract: BACKGROUND
  The 7th edition of the TNM American Joint Committee on Cancer classification incorporates mitotic rate (MR) only for primary cutaneous melanoma (PCM) with Breslow thickness (BT) ≤1 mm.
  
  
  OBJECTIVE
  To investigate whether and to what extent MR is able to predict sentinel lymph node (SLN) status and clinical outcome of PCM patients with BT >1 mm.
  
  
  METHODS
  The study included consecutive patients with PCM. Logistic regression and Cox regression model were used to analyze the impact of MR on SLN status, disease-free survival (DFS), and overall survival.
  
  
  RESULTS
  From 1998 to 2015, 1524 PCM (median age 57.8 years) cases were diagnosed with a BT >1 mm in six centers of the Italian Melanoma Intergroup. Median follow-up was 5.0 years. By multivariate analysis, MR was associated with SLN positivity (odds ratio 1.98, 95% confidence interval [CI] 1.12-3.50, P = .018). After adjusting for BT, ulceration, age, sex, and SLN status, MR correlated with a poor DFS (hazard ratio 1.52, 95% CI 1.18-1.97, P = .002) and overall survival (hazard ratio 1.63, 95% CI 1.17-2.29, P = .004).
  
  
  CONCLUSIONS
  Retrospective analysis.
  
  
  CONCLUSIONS
  MR is an independent prognostic factor for PCM patients with BT >1 mm. Incorporating this tissue biomarker could provide a better stratification of patients entering clinical trials in the adjuvant setting.
authors.affiliation: Unit of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy. Electronic address: mariomandala@tin.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Mandalà
authors.affiliation: Methodology for Clinical Research Laboratory, IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Galli
authors.affiliation: Unit of Pathology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cattaneo
authors.affiliation: Unit of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Merelli
authors.affiliation: Methodology for Clinical Research Laboratory, IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
authors.forename: Eliana
authors.initials: E
authors.lastname: Rulli
authors.affiliation: Section of Dermatology, Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Ribero
authors.affiliation: Section of Dermatology, Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Quaglino
authors.affiliation: Department of Dermatology, University of Florence, Florence, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Giorgi
authors.affiliation: Unit of Medical Oncology, Istituto Oncologico Veneto, Padua, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Pigozzo
authors.affiliation: Unit of Medical Oncology, Istituto Oncologico Veneto, Padua, Italy.
authors.forename: Vanna Chiarion
authors.initials: VC
authors.lastname: Sileni
authors.affiliation: Unit of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Chirco
authors.affiliation: Medical Oncology of Melanoma, European Institute of Oncology, Milan, Italy.
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Ferrucci
authors.affiliation: Azienda Ospedaliera Santa Croce e Carle di Cuneo SC Oncologia, Cuneo, Italy.
authors.forename: Marcella
authors.initials: M
authors.lastname: Occelli
authors.affiliation: Unit of Dermatology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Imberti
authors.affiliation: Unit of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Piazzalunga
authors.affiliation: Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Massi
authors.affiliation: Unit of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Tondini
authors.affiliation: Department of Medical Oncology, National Institute for Cancer Research, IRCCS San Martino, Genoa, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Queirolo
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000235:genetics* / Q000473:pathology*; D008875:Middle Aged; D008940:Mitotic Index; D011379:Prognosis; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node; D012878:Skin Neoplasms / Q000235:genetics* / Q000473:pathology*; D047368:Tumor Burden
keywords: cutaneous melanoma; disease-free survival; mitotic rate; outcome; overall survival; prognosis; sentinel lymph node