Age as a predictor of sentinel node metastasis among patients with localized melanoma: an inverse correlation of melanoma mortality and incidence of sentinel node metastasis among young and old patients

Abstract

Purpose: We have previously reported that older patients with clinical stage I and II primary cutaneous. Melanoma had lower survival rates compared to younger patients. We postulated that the incidence of nodal metastasis would therefore be higher among older melanoma patients.

Methods: The expanded American Joint Committee on Cancer melanoma staging database contains a cohort of 7,756 melanoma patients who presented without clinical evidence of regional lymph node or distant metastasis and who underwent a sentinel node biopsy procedure as a component of their staging assessment.

Results: Although older patients had primary melanoma features associated with more aggressive biology, we paradoxically observed a significant decrease in the incidence of sentinel node metastasis as patient age increased. Overall, the highest incidence of sentinel node metastasis was 25.8 % in patients under 20 years of age, compared to 15.5 % in patients 80 years and older (p < 0.001). In contrast, 5-year mortality rates for clinical stage II patients ranged from a low of 20 % for those 20-40 years of age up to 38 % for those over 70 years of age. Patient age was an independent predictor of sentinel node metastasis in a multifactorial analysis (p < 0.001).

Conclusions: Patients with clinical stage I and II melanoma under 20 years of age had a higher incidence of sentinel lymph node metastasis but, paradoxically, a more favorable survival outcome compared to all other age groups. In contrast, patients >70 years had the most aggressive primary melanoma features and a higher mortality rate compared to all other age groups but a lower incidence of sentinel lymph node metastasis.

Figure 1

Figure 1A: Incidence of sentinel node metastasis among patients presenting with clinically localized melanoma (Clinical Stage I and II) sorted by patient age in decades. The differences were statistically significant between the clinical stages (p<0.0001)and between the younger and older age groups (p=0.0001) 1B: Incidence of sentinel node metastases among patients presenting with thicker but clinically localized melanoma (Clinical Stage IIA, IIB, and IIC) sorted by patient age in decades. The differences were statistically significant among the clinical substages and between the younger and older age groups (p<0.0001) Figure 1C: : Incidence on sentinel node metastases among patients presenting with T3 and T4 melanomas with clinically negative nodal disease (Clinical T3a, T3b, T4a, T4b ) with and without tumor ulceration and sorted by patient age in decades. The differences among the age groups were significant (p<0.0001) Figure 1D: Declining incidence of sentinel node metastases with patient age and increasing mortality among clinical stage II melanoma patients despite increasing five-year melanoma-specific mortality rates (p<0.0001).

Figure 1

Figure 1A: Incidence of sentinel node metastasis among patients presenting with clinically localized melanoma (Clinical Stage I and II) sorted by patient age in decades. The differences were statistically significant between the clinical stages (p<0.0001)and between the younger and older age groups (p=0.0001) 1B: Incidence of sentinel node metastases among patients presenting with thicker but clinically localized melanoma (Clinical Stage IIA, IIB, and IIC) sorted by patient age in decades. The differences were statistically significant among the clinical substages and between the younger and older age groups (p<0.0001) Figure 1C: : Incidence on sentinel node metastases among patients presenting with T3 and T4 melanomas with clinically negative nodal disease (Clinical T3a, T3b, T4a, T4b ) with and without tumor ulceration and sorted by patient age in decades. The differences among the age groups were significant (p<0.0001) Figure 1D: Declining incidence of sentinel node metastases with patient age and increasing mortality among clinical stage II melanoma patients despite increasing five-year melanoma-specific mortality rates (p<0.0001).

Figure 1

Figure 1A: Incidence of sentinel node metastasis among patients presenting with clinically localized melanoma (Clinical Stage I and II) sorted by patient age in decades. The differences were statistically significant between the clinical stages (p<0.0001)and between the younger and older age groups (p=0.0001) 1B: Incidence of sentinel node metastases among patients presenting with thicker but clinically localized melanoma (Clinical Stage IIA, IIB, and IIC) sorted by patient age in decades. The differences were statistically significant among the clinical substages and between the younger and older age groups (p<0.0001) Figure 1C: : Incidence on sentinel node metastases among patients presenting with T3 and T4 melanomas with clinically negative nodal disease (Clinical T3a, T3b, T4a, T4b ) with and without tumor ulceration and sorted by patient age in decades. The differences among the age groups were significant (p<0.0001) Figure 1D: Declining incidence of sentinel node metastases with patient age and increasing mortality among clinical stage II melanoma patients despite increasing five-year melanoma-specific mortality rates (p<0.0001).

Figure 1

Figure 1A: Incidence of sentinel node metastasis among patients presenting with clinically localized melanoma (Clinical Stage I and II) sorted by patient age in decades. The differences were statistically significant between the clinical stages (p<0.0001)and between the younger and older age groups (p=0.0001) 1B: Incidence of sentinel node metastases among patients presenting with thicker but clinically localized melanoma (Clinical Stage IIA, IIB, and IIC) sorted by patient age in decades. The differences were statistically significant among the clinical substages and between the younger and older age groups (p<0.0001) Figure 1C: : Incidence on sentinel node metastases among patients presenting with T3 and T4 melanomas with clinically negative nodal disease (Clinical T3a, T3b, T4a, T4b ) with and without tumor ulceration and sorted by patient age in decades. The differences among the age groups were significant (p<0.0001) Figure 1D: Declining incidence of sentinel node metastases with patient age and increasing mortality among clinical stage II melanoma patients despite increasing five-year melanoma-specific mortality rates (p<0.0001).