This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kammula, U. S. Articles by Coit, D. G. Search for Related Content PubMed PubMed Citation Articles by Kammula, U. S. Articles by Coit, D. G. Social Bookmarking                            What's this?

Serial Follow-Up and the Prognostic Significance of Reverse Transcriptase-Polymerase Chain Reaction—Staged Sentinel Lymph Nodes From Melanoma Patients

From the Departments of Surgery and Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY

Address reprint requests to Udai S. Kammula, MD, Surgery Branch, National Cancer Institute, Building 10, Room 2B04, 10 Center Dr MSC 1502, Bethesda, MD 20892-1502; e-mail: udai_kammula{at}nih.gov

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 histologically 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 histologically 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.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. Mocellin, D. S.B. Hoon, P. Pilati, C. R. Rossi, and D. Nitti Sentinel Lymph Node Molecular Ultrastaging in Patients With Melanoma: A Systematic Review and Meta-Analysis of Prognosis J. Clin. Oncol., April 20, 2007; 25(12): 1588 - 1595. [Abstract] [Full Text] [PDF]

				S. N. Markovic, L. A. Erickson, R. D. Rao, R. H. Weenig, B. A. Pockaj, A. Bardia, C. M. Vachon, S. E. Schild, R. R. McWilliams, J. L. Hand, et al. Malignant Melanoma in the 21st Century, Part 2: Staging, Prognosis, and Treatment Mayo Clin. Proc., April 1, 2007; 82(4): 490 - 513. [Abstract] [Full Text] [PDF]

				S. L. Chen, D. M. Iddings, R. P. Scheri, and A. J. Bilchik Lymphatic Mapping and Sentinel Node Analysis: Current Concepts and Applications CA Cancer J Clin, September 1, 2006; 56(5): 292 - 309. [Abstract] [Full Text] [PDF]

				C. R. Scoggins, M. I. Ross, D. S. Reintgen, R. D. Noyes, J. S. Goydos, P. D. Beitsch, M. M. Urist, S. Ariyan, B. S. Davidson, J. J. Sussman, et al. Prospective Multi-Institutional Study of Reverse Transcriptase Polymerase Chain Reaction for Molecular Staging of Melanoma J. Clin. Oncol., June 20, 2006; 24(18): 2849 - 2857. [Abstract] [Full Text] [PDF]

				K. R. Lindsey, L. Gritz, R. Sherry, A. Abati, P. A. Fetsch, L. C. Goldfeder, M. I. Gonzales, K. A. Zinnack, L. Rogers-Freezer, L. Haworth, et al. Evaluation of Prime/Boost Regimens Using Recombinant Poxvirus/Tyrosinase Vaccines for the Treatment of Patients with Metastatic Melanoma Clin. Cancer Res., April 15, 2006; 12(8): 2526 - 2537. [Abstract] [Full Text] [PDF]

				C. F. Basil, Y. Zhao, K. Zavaglia, P. Jin, M. C. Panelli, S. Voiculescu, S. Mandruzzato, H. M. Lee, B. Seliger, R. S. Freedman, et al. Common cancer biomarkers. Cancer Res., March 15, 2006; 66(6): 2953 - 2961. [Abstract] [Full Text] [PDF]

				R. F. Uren Sentinel Lymph Node Biopsy in Melanoma J. Nucl. Med., February 1, 2006; 47(2): 191 - 195. [Full Text] [PDF]

				A. Romanini, G. Manca, D. Pellegrino, R. Murr, S. Sarti, F. Bianchi, A. AlSharif, C. Orlandini, V. Zucchi, M. Castagna, et al. Molecular staging of the sentinel lymph node in melanoma patients: correlation with clinical outcome Ann. Onc., November 1, 2005; 16(11): 1832 - 1840. [Abstract] [Full Text] [PDF]

				D. Talantov, A. Mazumder, J. X. Yu, T. Briggs, Y. Jiang, J. Backus, D. Atkins, and Y. Wang Novel Genes Associated with Malignant Melanoma but not Benign Melanocytic Lesions Clin. Cancer Res., October 15, 2005; 11(20): 7234 - 7242. [Abstract] [Full Text] [PDF]

				T. G. Zogakis, R. Essner, H.-j. Wang, R. R. Turner, Y. T. Takasumi, R. L. Gaffney, J. H. Lee, and D. L. Morton Melanoma Recurrence Patterns After Negative Sentinel Lymphadenectomy Arch Surg, September 1, 2005; 140(9): 865 - 872. [Abstract] [Full Text] [PDF]

				A. Ulmer, J. R. Fischer, S. Schanz, K. Sotlar, H. Breuninger, K. Dietz, G. Fierlbeck, and C. A. Klein Detection of Melanoma Cells Displaying Multiple Genomic Changes in Histopathologically Negative Sentinel Lymph Nodes Clin. Cancer Res., August 1, 2005; 11(15): 5425 - 5432. [Abstract] [Full Text] [PDF]

				U. S. Kammula and D. G. Coit In Reply: J. Clin. Oncol., June 1, 2005; 23(16): 3864 - 3865. [Full Text] [PDF]