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

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.

• Authors: David Y Lee, Briana J Lau, Kelly T Huynh, Devin C Flaherty, Ji-Hey Lee, Stacey L Stern, Steve J O'Day, Leland J Foshag, Mark B Faries
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 223 Issue 1 Pg. 9-18 (07 2016) ISSN: 1879-1190 [Electronic] United States
• PMID: 27236435 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Child, Preschool
• Databases, Factual
• Female
• Follow-Up Studies
• Humans
• Lymph Node Excision
• Lymphatic Metastasis
• Male
• Melanoma (mortality, pathology, surgery)
• Middle Aged
• Retrospective Studies
• Sentinel Lymph Node (pathology, surgery)
• Sentinel Lymph Node Biopsy
• Skin Neoplasms (mortality, pathology, surgery)
• Survival Analysis
• Treatment Outcome
• Young Adult