Outcome of clinical stage III melanoma patients with FDG-PET and whole-body CT added to the diagnostic workup

Ann Surg Oncol. 2013 Sep;20(9):3098-105. doi: 10.1245/s10434-013-2969-7. Epub 2013 Apr 24.

Abstract

Background: Combined whole-body FDG-PET and CT provide the most comprehensive staging of melanoma patients with palpable lymph node metastases (LNM). The aim of this study is to analyze survival of FDG-PET and CT negative or positive melanoma patients and to assess which factors have independent prognostic impact on survival of these patients.

Methods: Patients with palpable and histologically or cytologically proven LNM of melanoma, referred to participating hospitals for examination with FDG-PET and CT, were selected from a previous study. Melanoma-specific survival (MSS) and disease-free period (DFP) were analyzed for FDG-PET and CT positive and negative patients using the Kaplan-Meier method. Cox-regression analysis was performed to analyze which patient or melanoma characteristics had significant impact on MSS or DFP.

Results: For all 252 patients 5-year MSS was 38.2%. For FDG-PET and CT negative and positive patients 5-year MSS was 47.6 and 16.9%, respectively. Disease-free period for FDG-PET and CT negative patients was 46.0% after 5 years. Gender, a positive FDG-PET and CT, LNM in axilla compared to head or neck, and presence of extranodal growth were independent factors for worse MSS in all patients. Positive FDG-PET and CT was the most important prognostic factor for MSS with a hazard ratio of 2.54 (95% CI, 1.55-4.17, P<0.001).

Conclusions: Staging melanoma patients with palpable LNM is more accurate when whole-body FDG-PET and CT is added to the diagnostic workup. Hence, FDG-PET and CT, preferably combined, are indicated in the staging of clinical stage III melanoma patients.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Fluorodeoxyglucose F18*
  • Follow-Up Studies
  • Humans
  • Lymphatic Metastasis
  • Male
  • Melanoma / diagnosis*
  • Melanoma / mortality*
  • Middle Aged
  • Multimodal Imaging*
  • Neoplasm Staging
  • Positron-Emission Tomography*
  • Prognosis
  • Radiopharmaceuticals*
  • Skin Neoplasms
  • Survival Rate
  • Tomography, X-Ray Computed*
  • Young Adult

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18

Supplementary concepts

  • Melanoma, Cutaneous Malignant