BACKGROUND: The benefit of completion lymph node dissection (CLND) in melanoma patients with a positive sentinel lymph node (SLN) remains unknown. METHODS: We identified patients with a positive SLN from 1994 to 2012. Patient and tumor characteristics, reasons for not undergoing CLND, patterns of recurrence, and melanoma-specific survival data were analyzed. RESULTS: Of 4,310 patients undergoing SLN biopsy (SLNB), 495 (11 %) had a positive SLN-167 (34 %) patients underwent nodal observation and 328 (66 %) had immediate CLND. Patients in the no-CLND group were older (66 vs. 56 years; p < 0.001) and more likely to have lower extremity lesions (57 vs. 42 %; p = 0.006). There were no differences in tumor thickness, Clark level of invasion, ulceration, or SLN tumor burden. Median follow-up was 23 and 80 months for the no-CLND and CLND groups, respectively, and median time to recurrence was similar at 9 and 12 months, respectively (p = 0.48). There was no difference in local and in transit recurrence rates between groups (16 %, no CLND, and 18 %, CLND; p = 0.48). Nodal disease as a site of first recurrence occurred in 15 % of patients in the no-CLND group and 6 % of CLND patients (p = 0.002). In contrast, systemic recurrences occurred in 8 % of no-CLND patients compared with 27 % of CLND patients (p < 0.001). While median recurrence-free survival was higher after CLND (34.5 vs. 20.9 months; p = 0.02), melanoma-specific survival was similar (not reached, no CLND vs. 110 months, CLND; p = 0.09). CONCLUSIONS: Immediate CLND after a positive SLNB is associated with fewer initial nodal basin recurrences but similar melanoma-specific survival. These results support ongoing equipoise in the Multicenter Selective Lymphadenectomy Trial II (MSLT-II).
BACKGROUND: The benefit of completion lymph node dissection (CLND) in melanomapatients with a positive sentinel lymph node (SLN) remains unknown. METHODS: We identified patients with a positive SLN from 1994 to 2012. Patient and tumor characteristics, reasons for not undergoing CLND, patterns of recurrence, and melanoma-specific survival data were analyzed. RESULTS: Of 4,310 patients undergoing SLN biopsy (SLNB), 495 (11 %) had a positive SLN-167 (34 %) patients underwent nodal observation and 328 (66 %) had immediate CLND. Patients in the no-CLND group were older (66 vs. 56 years; p < 0.001) and more likely to have lower extremity lesions (57 vs. 42 %; p = 0.006). There were no differences in tumor thickness, Clark level of invasion, ulceration, or SLN tumor burden. Median follow-up was 23 and 80 months for the no-CLND and CLND groups, respectively, and median time to recurrence was similar at 9 and 12 months, respectively (p = 0.48). There was no difference in local and in transit recurrence rates between groups (16 %, no CLND, and 18 %, CLND; p = 0.48). Nodal disease as a site of first recurrence occurred in 15 % of patients in the no-CLND group and 6 % of CLND patients (p = 0.002). In contrast, systemic recurrences occurred in 8 % of no-CLND patients compared with 27 % of CLND patients (p < 0.001). While median recurrence-free survival was higher after CLND (34.5 vs. 20.9 months; p = 0.02), melanoma-specific survival was similar (not reached, no CLND vs. 110 months, CLND; p = 0.09). CONCLUSIONS: Immediate CLND after a positive SLNB is associated with fewer initial nodal basin recurrences but similar melanoma-specific survival. These results support ongoing equipoise in the Multicenter Selective Lymphadenectomy Trial II (MSLT-II).
Authors: Mark B Faries; John F Thompson; Alistair J Cochran; Robert H Andtbacka; Nicola Mozzillo; Jonathan S Zager; Tiina Jahkola; Tawnya L Bowles; Alessandro Testori; Peter D Beitsch; Harald J Hoekstra; Marc Moncrieff; Christian Ingvar; Michel W J M Wouters; Michael S Sabel; Edward A Levine; Doreen Agnese; Michael Henderson; Reinhard Dummer; Carlo R Rossi; Rogerio I Neves; Steven D Trocha; Frances Wright; David R Byrd; Maurice Matter; Eddy Hsueh; Alastair MacKenzie-Ross; Douglas B Johnson; Patrick Terheyden; Adam C Berger; Tara L Huston; Jeffrey D Wayne; B Mark Smithers; Heather B Neuman; Schlomo Schneebaum; Jeffrey E Gershenwald; Charlotte E Ariyan; Darius C Desai; Lisa Jacobs; Kelly M McMasters; Anja Gesierich; Peter Hersey; Steven D Bines; John M Kane; Richard J Barth; Gregory McKinnon; Jeffrey M Farma; Erwin Schultz; Sergi Vidal-Sicart; Richard A Hoefer; James M Lewis; Randall Scheri; Mark C Kelley; Omgo E Nieweg; R Dirk Noyes; Dave S B Hoon; He-Jing Wang; David A Elashoff; Robert M Elashoff Journal: N Engl J Med Date: 2017-06-08 Impact factor: 91.245
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: J Am Coll Surg Date: 2016-01-29 Impact factor: 6.113
Authors: Kristy K Broman; Tasha M Hughes; Lesly A Dossett; James Sun; Michael J Carr; Dennis A Kirichenko; Avinash Sharma; Edmund K Bartlett; Amanda Ag Nijhuis; John F Thompson; Tina J Hieken; Lisa Kottschade; Jennifer Downs; David E Gyorki; Emma Stahlie; Alexander van Akkooi; David W Ollila; Jill Frank; Yun Song; Giorgos Karakousis; Marc Moncrieff; Jenny Nobes; John Vetto; Dale Han; Jeffrey Farma; Jeremiah L Deneve; Martin D Fleming; Matthew Perez; Kirsten Baecher; Michael Lowe; Roger Olofsson Bagge; Jan Mattsson; Ann Y Lee; Russell S Berman; Harvey Chai; Hidde M Kroon; Roland M Teras; Juri Teras; Norma E Farrow; Georgia M Beasley; Jane Yc Hui; Lukas Been; Schelto Kruijff; David Boulware; Amod A Sarnaik; Vernon K Sondak; Jonathan S Zager Journal: J Am Coll Surg Date: 2020-12-13 Impact factor: 6.532