Gene expression profiling for molecular staging of cutaneous melanoma in patients undergoing sentinel lymph node biopsy

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Background:A gene expression profile (GEP) test able to accurately identify risk of metastasis for patients with cutaneous melanoma has been clinically validated.Objective:We aimed for assessment of the prognostic accuracy of GEP and sentinel lymph node biopsy (SLNB) tests, independently and in combination, in a multicenter cohort of 217 patients.Methods:Reverse transcription polymerase chain reaction (RT-PCR) was performed to assess the expression of 31 genes from primary melanoma tumors, and SLNB outcome was determined from clinical data. Prognostic accuracy of each test was determined using Kaplan-Meier and Cox regression analysis of disease-free, distant metastasis–free, and overall survivals.Results:GEP outcome was a more significant and better predictor of each end point in univariate and multivariate regression analysis, compared with SLNB (P < .0001 for all). In combination with SLNB, GEP improved prognostication. For patients with a GEP high-risk outcome and a negative SLNB result, Kaplan-Meier 5-year disease-free, distant metastasis–free, and overall survivals were 35%, 49%, and 54%, respectively.Limitations:Within the SLNB-negative cohort of patients, overall risk of metastatic events was higher (˜30%) than commonly found in the general population of patients with melanoma.Conclusions:In this study cohort, GEP was an objective tool that accurately predicted metastatic risk in SLNB-eligible patients.

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