A nomogram that predicts the presence of sentinel node metastasis in melanoma with better discrimination than the American joint committee on cancer staging system Journal Article

  

Authors:	Wong, S. L.; Kattan, M. W.; McMasters, K. M.; Coit, D. G.
Article Title:	A nomogram that predicts the presence of sentinel node metastasis in melanoma with better discrimination than the American joint committee on cancer staging system
Abstract:	Background: The threshold and indications for sentinel lymph node (SLN) biopsy in patients with melanoma remain somewhat arbitrary. Many variables associated with SLN positivity have previously been identified, including a significant association between the American Joint Committee on Cancer (AJCC) staging system and SLN status. We developed a user-friendly nomogram that takes several characteristics into account simultaneously to more accurately predict the presence of SLN metastasis for an individual patient. Methods: A total of 979 patients who underwent successful SLN biopsy for cutaneous melanoma at a single institution between February 1991 and November 2003 were included in the analysis. Predictors were used to develop a nomogram, based on logistic regression analysis, to predict the probability of SLN positivity. A large multi-institutional trial with 3108 patients was used to validate the predictive accuracy of the nomogram compared with the AJCC staging system. Results: The nomogram was developed and found to be accurate and discriminating. The concordance index of the nomogram, a measure of predictive ability, was .694 when evaluated with the validation dataset. In contrast, the concordance index of the AJCC staging system was lower (.663; P < .001). Conclusions: Using commonly available clinicopathologic information, we developed a nomogram to accurately predict the probability of a positive SLN in patients with melanoma. This tool takes several characteristics into account simultaneously. This model should enable improved patient counseling and treatment selection. © 2005 The Society of Surgical Oncology, Inc.
Keywords:	adult; controlled study; middle aged; major clinical study; validation process; cancer patient; cancer staging; lymph node metastasis; lymphatic metastasis; neoplasm staging; sentinel lymph node; prospective studies; sentinel lymph node biopsy; accuracy; reproducibility of results; melanoma; skin neoplasms; logistic models; prediction; evaluation; probability; nomograms; measurement; predictive value of tests; intermethod comparison; health care organization; logistic regression analysis; nomogram; sentinel node biopsy; health center
Journal Title:	Annals of Surgical Oncology
Volume:	12
Issue:	4
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2005-04-01
Start Page:	282
End Page:	288
Language:	English
DOI:	10.1245/aso.2005.05.016
PUBMED:	15827679
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-18144383153&partnerID=40&md5=f0e89340c17e4af9cf7453b5b75146f0
Notes:	--- - "Cited By (since 1996): 39" - "Export Date: 24 October 2012" - "CODEN: ASONF" - "Source: Scopus"

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