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. 2016 Jul;223(1):9-18.
doi: 10.1016/j.jamcollsurg.2016.01.045. Epub 2016 Jan 29.

Impact of Completion Lymph Node Dissection on Patients with Positive Sentinel Lymph Node Biopsy in Melanoma

David Y Lee  1 , Briana J Lau  1 , Kelly T Huynh  1 , Devin C Flaherty  1 , Ji-Hey Lee  2 , Stacey L Stern  2 , Steve J O'Day  3 , Leland J Foshag  1 , Mark B Faries  4
Affiliations

Impact of Completion Lymph Node Dissection on Patients with Positive Sentinel Lymph Node Biopsy in Melanoma

David Y Lee et al. J Am Coll Surg. 2016 Jul.

Abstract

Background: Whether patients with positive SLNB should undergo complete lymph node dissection (CLND) is an important unanswered clinical question.

Study design: Patients diagnosed with positive SLNB at a melanoma referral center from 1991 to 2013 were studied. Outcomes of patients who underwent CLND were compared with those who did not undergo immediate CLND (observation [OBS] group).

Results: There were 471 patients who had positive SLNB; 375 (79.6%) in the CLND group and 96 (20.4%) in the OBS group. The groups were similar except that the CLND group was younger and had more sentinel nodes removed. Five-year nodal recurrence-free survival was significantly better in the CLND group compared with the OBS group (93.1% vs 84.4%; p = 0.005). However, 5-year (66.4% vs 55.2%) and 10-year (59.5% vs 45.0%) distant metastasis-free survival rates were not significantly different (p = 0.061). The CLND group's melanoma-specific survival (MSS) rate was superior to that of the OBS group; 5-year MSS rates were 73.7% vs 65.5% and 10-year MSS rates were 66.8% vs 48.3% (p = 0.015). On multivariate analysis, CLND was associated with improved MSS (hazard ratio = 0.60; 95% CI, 0.40-0.89; p = 0.011) and lower nodal recurrence (hazard ratio = 0.46; 95% CI, 0.24-0.86; p = 0.016). Increased Breslow thickness, older age, ulceration, and trunk melanoma were all associated with worse outcomes. On subgroup analysis, the following factors were associated with better outcomes from CLND: male sex, nonulcerated primary, intermediate thickness, Clark level IV or lower extremity tumors.

Conclusions: Treatment of positive SLNB with CLND was associated with improved MSS and nodal recurrence rates. Follow-up beyond 5 years was needed to see a significant difference in MSS rates.

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Figures

Fig 1
Fig 1
(A) Recurrence-free survival comparison between completion lymph node dissection (CLND) and observation (OBS). (B) Regional recurrence-free survival comparison between CLND and OBS. (C) Cumulative incidence of nodal metastasis comparison between CLND and OBS. (D) Distance recurrence-free survival comparison between CLND and OBS. OBS, Observation
Fig 1
Fig 1
(A) Recurrence-free survival comparison between completion lymph node dissection (CLND) and observation (OBS). (B) Regional recurrence-free survival comparison between CLND and OBS. (C) Cumulative incidence of nodal metastasis comparison between CLND and OBS. (D) Distance recurrence-free survival comparison between CLND and OBS. OBS, Observation
Fig 1
Fig 1
(A) Recurrence-free survival comparison between completion lymph node dissection (CLND) and observation (OBS). (B) Regional recurrence-free survival comparison between CLND and OBS. (C) Cumulative incidence of nodal metastasis comparison between CLND and OBS. (D) Distance recurrence-free survival comparison between CLND and OBS. OBS, Observation
Fig 1
Fig 1
(A) Recurrence-free survival comparison between completion lymph node dissection (CLND) and observation (OBS). (B) Regional recurrence-free survival comparison between CLND and OBS. (C) Cumulative incidence of nodal metastasis comparison between CLND and OBS. (D) Distance recurrence-free survival comparison between CLND and OBS. OBS, Observation
Fig 2
Fig 2
(A) Melanoma specific free survival comparison between completion lymph node dissection (CLND) and observation. (B) Subgroup analysis of melanoma specific survival (MSS). OBS, observation.
Fig 2
Fig 2
(A) Melanoma specific free survival comparison between completion lymph node dissection (CLND) and observation. (B) Subgroup analysis of melanoma specific survival (MSS). OBS, observation.
Fig 3
Fig 3
(A) Distant recurrence-free survival comparison between salvage completion lymph node dissection (CLND) vs immediate CLND patients with additional tumor-positive non-sentinel nodes. (B) Melanoma specific survival comparison between salvage CLND vs immediate CLND patients with additional tumor-positive non-sentinel nodes. OBS, observation.
Fig 3
Fig 3
(A) Distant recurrence-free survival comparison between salvage completion lymph node dissection (CLND) vs immediate CLND patients with additional tumor-positive non-sentinel nodes. (B) Melanoma specific survival comparison between salvage CLND vs immediate CLND patients with additional tumor-positive non-sentinel nodes. OBS, observation.
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Comment in

  • Discussion.
    [No authors listed] [No authors listed] J Am Coll Surg. 2016 Jul;223(1):18-9. doi: 10.1016/j.jamcollsurg.2016.04.025. J Am Coll Surg. 2016. PMID: 27345897 No abstract available.

References

    1. Morton DL, Cochran AJ, Thompson JF, et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg. 2005 Sep;242(3):302–11. discussion 11-3. - PMC - PubMed
    1. Morton DL CL, Wong J. Intraoperative lymphatic mapping and selective lymphadenectomy: Technical details of a new procedure for clinical stage I melanoma.. 42nd Annual Meeting of the Society of Surgical Oncology; Washington, DC. 1990 May 20-22; 1990. 1990.
    1. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014 Feb 13;370(7):599–609. - PMC - PubMed
    1. Nowecki ZI, Rutkowski P, Nasierowska-Guttmejer A, Ruka W. Sentinel lymph node biopsy in melanoma patients with clinically negative regional lymph nodes--one institution's experience. Melanoma Res. 2003 Feb;13(1):35–43. - PubMed
    1. Rutkowski P, Nowecki ZI, Nasierowska-Guttmejer A, Ruka W. Lymph node status and survival in cutaneous malignant melanoma--sentinel lymph node biopsy impact. Eur J Surg Oncol. 2003 Sep;29(7):611–8. - PubMed

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