Serial follow-up and the prognostic significance of reverse transcriptase-polymerase chain reaction-staged sentinel lymph nodes from melanoma patients Journal Article

Authors: Kammula, U. S.; Ghossein, R.; Bhattacharya, S.; Coit, D. G.
Article Title: Serial follow-up and the prognostic significance of reverse transcriptase-polymerase chain reaction-staged sentinel lymph nodes from melanoma patients
Abstract: Purpose: Reverse transcriptase-polymerase chain reaction (RT-PCR) may provide an extremely sensitive method for detection of occult nodal disease. We evaluated the role of a single-marker RT-PCR assay for tyrosinase mRNA in the detection of melanoma sentinel lymph node (SLN) metastases and correlated the results with long-term clinical outcome. Patients and Methods: One hundred twelve patients who underwent SLN biopsy for melanoma were prospectively analyzed. SLNs were bivalved, with half of each specimen evaluated by histologic methods and the other half evaluated by nested RT-PCR for tyrosinase. Results: Fifteen patients (13%) had historically positive SLNs, all of whom were also positive by RT-PCR (HISTO+/PCR+). Thirty-nine patients (35%) had SLNs that were negative by both histology and RT-PCR (HISTO-/PCR-). Fifty-eight patients (52%) were historically negative but upstaged with a positive RT-PCR result (HISTO-/PCR+). Initially, at a median follow-up of 42 months, recurrence rates among the three cohorts were statistically different (HISTO+/PCR+, 53%; HISTO-/PCR+, 14%; and HISTO-/PCR-, 0%). However, at a longer median follow-up (67 months), recurrence rates for the HISTO-/PCR+ (24%) and HISTO-/PCR- (15%) groups were no longer statistically different (P = .25). The median time to relapse between the HISTO-/PCR+ and HISTO-/PCR- groups differed by 10 months (31 v 41 months, respectively). Conclusion: With extended follow-up of patients with histologically negative SLNs, detection of submicroscopic disease by tyrosinase RT-PCR does not define a subgroup that is at higher recurrence risk when compared with patients with RT-PCR-negative SLNs. Future studies evaluating molecular staging will require approximately 5 years of median follow-up to accurately define outcome for patients with occult melanoma metastases.
Keywords: adolescent; adult; controlled study; aged; disease-free survival; middle aged; survival rate; major clinical study; genetics; clinical trial; histopathology; cancer recurrence; cancer risk; disease free survival; cancer staging; follow up; follow-up studies; lymph node metastasis; lymphatic metastasis; sensitivity and specificity; sentinel lymph node biopsy; melanoma; reverse transcription polymerase chain reaction; skin neoplasms; tumor markers, biological; pathology; tumor marker; rna; skin tumor; messenger rna; reverse transcriptase polymerase chain reaction; prediction and forecasting; predictive value of tests; cancer relapse; monophenol monooxygenase; rna, neoplasm; paraffin; paraffin embedding; humans; prognosis; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 22
Issue: 19
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2004-10-01
Start Page: 3989
End Page: 3996
Language: English
DOI: 10.1200/jco.2004.03.052
PROVIDER: scopus
PUBMED: 15459222
Notes: J. Clin. Oncol. -- Cited By (since 1996):57 -- Export Date: 16 June 2014 -- CODEN: JCOND -- Source: Scopus
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MSK Authors
  1. Ronald A Ghossein
    302 Ghossein
  2. Daniel Coit
    422 Coit