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| |  Optimal Lymph Node Ratio Possible in Most Melanoma Patients Undergoing Lymph Node Dissection: Presented at SSO By Jill Stein ST. LOUIS, Mo -- March 8, 2010 -- An optimal lymph node ratio (LNR) is an achievable goal in the majority of patients with stage III melanoma undergoing lymph node dissection, with fewer outliers observed over time, according to a study presented here on March 6 at the 2010 Society of Surgical Oncology Annual Cancer Symposium (SSO). Neha Goel, University of Texas M. D. Anderson Cancer Center, Houston, Texas, and colleagues examined LNR thresholds as performance indicators of lymph node surgery for both the axillary and inguinofemoral regions in the treatment of stage III melanoma. Lymph node ratio, defined as the number of metastatic lymph nodes divided by the total number of lymph nodes removed, has been found to be an important prognostic indicator for disease-specific survival in patients with stage III melanoma. Optimal LNR thresholds for melanoma have been reported as <=0.13 and <=0.18 for the axillary and inguinofemoral regions, respectively, with significant differences in disease-specific survival. For the study, the researchers reviewed clinicopathologic data in 794 patients who underwent axillary or inguinofemoral lymphadenectomy for melanoma at their institution from 1990 to 2001. The aim of their study was to determine whether these thresholds are achieved in clinical practice. The study found that optimal LNR was achieved in 66% of patients undergoing lymph node surgery. The mean axillary LNR decreased over time from 0.27 in 1993 to 0.09 in 2001. The mean inguinal LNR decreased over time from 0.34 in 1992 to 0.10 in 2001. The process control procedure demonstrated that 6% and 4% of LNRs were statistical outliers for the axillary and inguinal regions, respectively. Before 1997, 8% of axillary and 6% of inguinal LNRs were outliers that decreased to 3% and 2% after 1997. The investigators said that there might be multiple possible reasons for decreasing LNRs over time. Possibilities include earlier diagnosis with fewer positive nodes in the era of sentinel lymph node biopsy and improved surgical pathologic techniques of lymph node retrieval from the surgical specimen. [Presentation title: Standards for Lymph Node Ratio in Dissections for Melanoma Patients: Can They Be Achieved? Abstract P 255]
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