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. 2014 Dec;140(12):1101-9.
doi: 10.1001/jamaoto.2014.2530.

Association of sentinel lymph node biopsy with survival for head and neck melanoma: survival analysis using the SEER database

Steven M Sperry  1 , Mary E Charlton  2 , Nitin A Pagedar  1
Affiliations

Association of sentinel lymph node biopsy with survival for head and neck melanoma: survival analysis using the SEER database

Steven M Sperry et al. JAMA Otolaryngol Head Neck Surg. 2014 Dec.

Abstract

Importance: Sentinel lymph node biopsy (SLNB) provides prognostic information for melanoma; however, a survival benefit has not been demonstrated.

Objective: To assess the association of SLNB with survival for melanoma arising in head and neck subsites (HNM).

Design, setting, and participants: Propensity score-matched retrospective cohort study using the Surveillance Epidemiology and End Results (SEER) database to compare US patients with HNM meeting current recommendations for SLNB, treated from 2004 to 2011 with either (1) SLNB with or without neck dissection, or (2) no SLNB or neck dissection.

Interventions: SLNB with or without neck dissection.

Main outcomes and measures: Disease-specific survival (DSS) estimates based on the Kaplan-Meier method, and Cox proportional hazards modeling to compare survival outcomes between matched pair cohorts.

Results: A total of 7266 patients with HNM meeting study criteria were identified from the SEER database. Matching of treatment cohorts was performed using propensity scores modeled on 10 covariates known to be associated with SLNB treatment or melanoma survival. Cohorts were stratified by tumor thickness (thin, >0.75-1.00 mm Breslow thickness; intermediate, >1.00-4.00 mm; and thick, >4.00 mm) and exactly matched within 5 age categories. In the intermediate-thickness cohort, 2808 patients with HNM were matched and balanced by propensity score for SLNB treatment; the 5-year DSS estimate for those treated by SLNB was 89% vs 88% for nodal observation (log-rank P = .30). The hazard ratio for melanoma-specific death was 0.87 for those undergoing SLNB (95% CI, 0.66-1.14; P = .31). In each of the other cohorts analyzed, including those with thin and thick melanomas, and cohorts with melanoma overall, no significant difference in DSS was demonstrated.

Conclusions and relevance: This SEER cohort analysis demonstrates no significant association between SLNB and improved disease-specific survival for patients with HNM.

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Figures

Figure 1
Figure 1. Propensity Score Distribution
Dot-plot demonstrating the distribution of propensity scores for SLNB (treatment) or no SLNB (control) in HNM patients, stratified into matched and unmatched categories.
Figure 2
Figure 2. Assessment of Balance Following Propensity-Score Matching
Histogram of standardized difference in means for all covariates and interaction terms A) before and B) after matching in the HNM cohort.
Figure 2
Figure 2. Assessment of Balance Following Propensity-Score Matching
Histogram of standardized difference in means for all covariates and interaction terms A) before and B) after matching in the HNM cohort.
Figure 3
Figure 3. Survival Analysis Stratified by Breslow Depth
Unadjusted melanoma disease-specific survival curves comparing SLNB intervention versus observation for HNM age 18-84, A) Overall, B) Thin, C) Intermediate, and D) Thick matched-pair cohorts. SLNB=Sentinel lymph node biopsy; Obs=Observation; N=Number of cases; KM= Kaplan-Meier; DSS= Disease-specific survival.
See this image and copyright information in PMC

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