Sentinel lymph node biopsy for T1b melanoma: Balancing prognostic value and cost Journal Article
| Authors: | Hu, Y.; Briggs, A.; Gennarelli, R. L.; Bartlett, E. K.; Ariyan, C. E.; Coit, D. G.; Brady, M. S. |
| Article Title: | Sentinel lymph node biopsy for T1b melanoma: Balancing prognostic value and cost |
| Abstract: | Background: The purpose of this study is to report the additional prognostic information and cost associated with sentinel lymph node biopsy (SLNB) for patients with T1b melanoma. Patients and Methods: An institutional database was queried for patients with T1b melanoma (0.8–1.0 mm or < 0.8 mm with ulceration) with at least 5 years of follow-up. Results of SLNB, completion lymphadenectomy (CLND), recurrence, and melanoma-specific survival (MSS) were assessed. Institutional costs of melanoma care were converted to Medicare proportional dollars. A Markov model was created to estimate long-term costs. Results: Among the total 392 patients, 238 underwent SLNB. Median follow-up was 10.5 years. SLNB was positive in 19 patients (8.0%). Patients who underwent SLNB had higher 10-year nodal recurrence-free survival (98.6% vs. 91.2%, p < 0.001) but not MSS (94.4% vs. 93.2%, p = 0.55). Ulceration (HR 4.7, p = 0.022) and positive sentinel node (HR 11.5, p < 0.001) were associated with worse MSS. Estimates for 5-year costs reflect a fourfold increase in total costs of care associated with SLNB. However, a treatment plan that forgoes adjuvant therapy for resected stage IIIA melanoma but offers systemic therapy for a node-basin recurrence would nullify the additional cost of SLNB. Conclusions: SLNB is prognostic for T1b melanoma. Its impact on the overall cost of melanoma care is intimately tied to systemic therapy in the adjuvant and recurrent settings. © 2020, Society of Surgical Oncology. |
| Keywords: | melanoma; cost-effectiveness; sentinel node biopsy |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 27 |
| Issue: | 13 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2020-12-01 |
| Start Page: | 5248 |
| End Page: | 5256 |
| Language: | English |
| DOI: | 10.1245/s10434-020-08558-8 |
| PUBMED: | 32514805 |
| PROVIDER: | scopus |
| PMCID: | PMC8366311 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2020 -- Source: Scopus |
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