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. 2021 Apr;232(4):424-431.
doi: 10.1016/j.jamcollsurg.2020.11.014. Epub 2020 Dec 13.

Surveillance of Sentinel Node-Positive Melanoma Patients with Reasons for Exclusion from MSLT-II: Multi-Institutional Propensity Score Matched Analysis

Kristy K Broman  1 , Tasha M Hughes  2 , Lesly A Dossett  2 , James Sun  3 , Michael J Carr  4 , Dennis A Kirichenko  5 , Avinash Sharma  6 , Edmund K Bartlett  6 , Amanda Ag Nijhuis  7 , John F Thompson  7 , Tina J Hieken  8 , Lisa Kottschade  9 , Jennifer Downs  10 , David E Gyorki  10 , Emma Stahlie  11 , Alexander van Akkooi  11 , David W Ollila  12 , Jill Frank  12 , Yun Song  13 , Giorgos Karakousis  13 , Marc Moncrieff  14 , Jenny Nobes  14 , John Vetto  15 , Dale Han  15 , Jeffrey Farma  16 , Jeremiah L Deneve  17 , Martin D Fleming  17 , Matthew Perez  18 , Kirsten Baecher  18 , Michael Lowe  18 , Roger Olofsson Bagge  19 , Jan Mattsson  19 , Ann Y Lee  20 , Russell S Berman  20 , Harvey Chai  21 , Hidde M Kroon  21 , Roland M Teras  22 , Juri Teras  22 , Norma E Farrow  23 , Georgia M Beasley  23 , Jane Yc Hui  24 , Lukas Been  25 , Schelto Kruijff  25 , David Boulware  4 , Amod A Sarnaik  26 , Vernon K Sondak  26 , Jonathan S Zager  26 ; International High-Risk Melanoma Consortium
Affiliations

Surveillance of Sentinel Node-Positive Melanoma Patients with Reasons for Exclusion from MSLT-II: Multi-Institutional Propensity Score Matched Analysis

Kristy K Broman et al. J Am Coll Surg. 2021 Apr.

Erratum in

Abstract

Background: In sentinel lymph node (SLN)-positive melanoma, two randomized trials demonstrated equivalent melanoma-specific survival with nodal surveillance vs completion lymph node dissection (CLND). Patients with microsatellites, extranodal extension (ENE) in the SLN, or >3 positive SLNs constitute a high-risk group largely excluded from the randomized trials, for whom appropriate management remains unknown.

Study design: SLN-positive patients with any of the three high-risk features were identified from an international cohort. CLND patients were matched 1:1 with surveillance patients using propensity scores. Risk of any-site recurrence, SLN-basin-only recurrence, and melanoma-specific mortality were compared.

Results: Among 1,154 SLN-positive patients, 166 had ENE, microsatellites, and/or >3 positive SLN. At 18.5 months median follow-up, 49% had recurrence (vs 26% in patients without high-risk features, p < 0.01). Among high-risk patients, 52 (31%) underwent CLND and 114 (69%) received surveillance. Fifty-one CLND patients were matched to 51 surveillance patients. The matched cohort was balanced on tumor, nodal, and adjuvant treatment factors. There were no significant differences in any-site recurrence (CLND 49%, surveillance 45%, p = 0.99), SLN-basin-only recurrence (CLND 6%, surveillance 14%, p = 0.20), or melanoma-specific mortality (CLND 14%, surveillance 12%, p = 0.86).

Conclusions: SLN-positive patients with microsatellites, ENE, or >3 positive SLN constitute a high-risk group with a 2-fold greater recurrence risk. For those managed with nodal surveillance, SLN-basin recurrences were more frequent, but all-site recurrence and melanoma-specific mortality were comparable to patients treated with CLND. Most recurrences were outside the SLN-basin, supporting use of nodal surveillance for SLN-positive patients with microsatellites, ENE, and/or >3 positive SLN.

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Figures

Figure 1.
Figure 1.
All-site recurrence-free survival for matched cohort of high-risk sentinel node-positive patients based on nodal management with surveillance vs completion lymph node dissection.
See this image and copyright information in PMC

Comment in

  • Invited Commentary.
    Delman KA. Delman KA. J Am Coll Surg. 2021 Apr;232(4):431-432. doi: 10.1016/j.jamcollsurg.2020.12.049. J Am Coll Surg. 2021. PMID: 33771300 No abstract available.

References

    1. Faries MB, Thompson JF, Cochran AJ, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med 2017;376:2211–2222. - PMC - PubMed
    1. Leiter U, Stadler R, Mauch C, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol 2016;17: 757–767. - PubMed
    1. Broman K, Hughes T, Dossett L, et al. Active surveillance of melanoma patients with sentinel node metastasis: an international multi-institution evaluation of post-MSLT-2 adoption and early outcomes. Cancer, in press - PMC - PubMed
    1. Leiter U, Stadler R, Mauch C, et al. Final analysis of DeCOG-SLT Trial: No survival benefit for complete lymph node dissection in patients with melanoma with positive sentinel node. J Clin Oncol 2019;37:3000–3008. - PubMed
    1. Wong SL, Faries MB, Kennedy EB, et al. Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. J Clin Oncol 2018;36:399–413. - PubMed

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