Lymphatic invasion is independently prognostic of metastasis in primary cutaneous melanoma
11/2011
Journal Article
Authors:
Xu, X.;
Chen, L.;
Guerry, D.;
Dawson, P. R.;
Hwang, W. T.;
VanBelle, P.;
Elder, D. E.;
Zhang, P. J.;
Ming, M. E.;
Schuchter, L.;
Gimotty, P. A.
Volume:
18
Pagination:
229-37
Issue:
1
Journal:
Clin Cancer Res
PMID:
22096024
URL:
https://www.ncbi.nlm.nih.gov/pubmed/22096024
DOI:
10.1158/1078-0432.CCR-11-0490
Keywords:
Biomarkers, Tumor/*metabolism Female Follow-Up Studies Humans Immunoenzyme Techniques Lymphatic Metastasis Male Melanoma/metabolism/*pathology Membrane Glycoproteins/*metabolism Middle Aged Neoplasm Invasiveness Prognosis Prospective Studies
Retrospective Studies Skin Neoplasms/metabolism/*secondary Survival Rate
Abstract:
PURPOSE: Lymphatic invasion (LI) in primary cutaneous melanomas was recently found to be common. In this study, we evaluated LI as an independent prognostic factor. EXPERIMENTAL DESIGN: This study included 251 patients with vertical growth phase (VGP) primary cutaneous melanomas who had paraffin-fixed lesional tissue and were in a prospective cohort seen between 1972 and 1991, had no clinical evidence of regional nodal disease at diagnosis, and had at least ten years of follow-up. Dual immunohistochemical staining was used to detect lymphatic endothelium (podoplanin) and melanoma cells (S-100). Multivariate logistic regression for ten-year metastasis was used to define independent prognostic factors, and a prognostic tree was developed to characterize and discriminate risk groups. Kaplan-Meier disease-free survival curves for those with and without LI within current American Joint Committee on Cancer stages were compared using the log-rank statistic. RESULTS: LI was observed in 43% (108 of 251) of the study melanomas. The multivariate model for ten-year metastasis identified four independent prognostic factors: tumor thickness, mitotic rate, LI, and anatomic site. The prognostic tree identified a group of patients with thin (</=1 mm thick) melanomas and poor prognosis: stage IB melanomas with LI. Survival curves for time to first metastasis showed significantly poorer prognosis for patients with LI compared with those without it for both stages IB and IIA. CONCLUSIONS: LI is common across the range of tumor thicknesses in primary VGP melanomas. It is an independent prognostic factor and significantly increases the risk of metastasis in patients in clinical stages IB and IIA.
