{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T12:06:00Z","timestamp":1773835560569,"version":"3.50.1"},"reference-count":45,"publisher":"American Association for the Advancement of Science (AAAS)","issue":"11","license":[{"start":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T00:00:00Z","timestamp":1601942400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81802636"],"award-info":[{"award-number":["81802636"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81802636"],"award-info":[{"award-number":["81802636"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Commun"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Whether non\u2010sentinel lymph node (SLN)\u2010positive melanoma patients can benefit from completion lymph node dissection (CLND) is still unclear. The current study was performed to identify the prognostic role of non\u2010SLN status in SLN\u2010positive melanoma and to investigate the predictive factors of non\u2010SLN metastasis in acral and cutaneous melanoma patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">The records of 328 SLN\u2010positive melanoma patients who underwent radical surgery at four cancer centers from September 2009 to August 2017 were reviewed. Clinicopathological data including age, gender, Clark level, Breslow index, ulceration, the number of positive SLNs, non\u2010SLN status, and adjuvant therapy were included for survival analyses. Patients were followed up until death or June 30, 2019. Multivariable logistic regression modeling was performed to identify factors associated with non\u2010SLN positivity. Log\u2010rank analysis and Cox regression analysis were used to identify the prognostic factors for disease\u2010free survival (DFS) and overall survival (OS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Among all enrolled patients, 220 (67.1%) had acral melanoma and 108 (32.9%) had cutaneous melanoma. The 5\u2010year DFS and OS rate of the entire cohort was 31.5% and 54.1%, respectively. More than 1 positive SLNs were found in 123 (37.5%) patients. Positive non\u2010SLNs were found in 99 (30.2%) patients. Patients with positive non\u2010SLNs had significantly worse DFS and OS (log\u2010rank\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Non\u2010SLN status (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.003), number of positive SLNs (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.016), and adjuvant therapy (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.025) were independent prognostic factors for DFS, while non\u2010SLN status (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.002), the Breslow index (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.027), Clark level (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.006), ulceration (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.004), number of positive SLNs (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.001), and adjuvant therapy (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.007) were independent prognostic factors for OS. The Breslow index (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.020), Clark level (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.012), and number of positive SLNs (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.031) were independently related to positive non\u2010SLNs and could be used to develop more personalized surgical strategy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Non\u2010SLN\u2010positive melanoma patients had worse DFS and OS even after immediate CLND than those with non\u2010SLN\u2010negative melanoma. The Breslow index, Clark level, and number of positive SLNs were independent predictive factors for non\u2010SLN status.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cac2.12101","type":"journal-article","created":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T01:53:35Z","timestamp":1602035615000},"page":"586-597","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The prognostic significance of non\u2010sentinel lymph node metastasis in cutaneous and acral melanoma patients\u2014A multicenter retrospective study"],"prefix":"10.34133","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2151-6420","authenticated-orcid":false,"given":"Wei","family":"Sun","sequence":"first","affiliation":[{"name":"Fudan University","place":["Shanghai, P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Xu","sequence":"additional","affiliation":[{"name":"Fudan University","place":["Shanghai, P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JiLong","family":"Yang","sequence":"additional","affiliation":[{"name":"Tianjin Medical University Cancer Hospital and Institute","place":["Tianjin, China"]},{"name":"Tianjin Medical University Cancer Hospital and Institute","place":["Tianjin, P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ZhiChao","family":"Liao","sequence":"additional","affiliation":[{"name":"Tianjin Medical University Cancer Hospital and Institute","place":["Tianjin, China"]},{"name":"Tianjin Medical University Cancer Hospital and Institute","place":["Tianjin, P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Li","sequence":"additional","affiliation":[{"name":"Zhejiang Cancer Hospital","place":["Hangzhou, P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Huang","sequence":"additional","affiliation":[{"name":"Brandon Regional Hospital","place":["Brandon, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Poulam","family":"Patel","sequence":"additional","affiliation":[{"name":"University of Nottingham","place":["Nottingham, UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"WangJun","family":"Yan","sequence":"additional","affiliation":[{"name":"Fudan University","place":["Shanghai, P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Chen","sequence":"additional","affiliation":[{"name":"Fudan University","place":["Shanghai, P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"221","published-online":{"date-parts":[[2020,10,6]]},"reference":[{"issue":"13","key":"e_1_3_2_2_2","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1056\/NEJMoa060992","article-title":"Sentinel\u2010node biopsy or nodal observation in melanoma","volume":"355","author":"Morton DL","year":"2006","unstructured":"Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R et\u00a0al. Sentinel\u2010node biopsy or nodal observation in melanoma. 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