Surveillance of sentinel node-positive melanoma patients with reasons for exclusion from MSLT-II: Multi-institutional propensity score matched analysis Journal Article
| Authors: | Broman, K. K.; Hughes, T. M.; Dossett, L. A.; Sun, J.; Carr, M. J.; Kirichenko, D. A.; Sharma, A.; Bartlett, E. K.; Nijhuis, A. A.; Thompson, J. F.; Hieken, T. J.; Kottschade, L.; Downs, J.; Gyorki, D. E.; Stahlie, E.; van Akkooi, A.; Ollila, D. W.; Frank, J.; Song, Y.; Karakousis, G.; Moncrieff, M.; Nobes, J.; Vetto, J.; Han, D.; Farma, J.; Deneve, J. L.; Fleming, M. D.; Perez, M.; Baecher, K.; Lowe, M.; Bagge, R. O.; Mattsson, J.; Lee, A. Y.; Berman, R. S.; Chai, H.; Kroon, H. M.; Teras, R. M.; Teras, J.; Farrow, N. E.; Beasley, G. M.; Hui, J. Y. C.; Been, L.; Kruijff, S.; Boulware, D.; Sarnaik, A. A.; Sondak, V. K.; Zager, J. S.; for the International High-Risk Melanoma Consortium |
| Article Title: | Surveillance of sentinel node-positive melanoma patients with reasons for exclusion from MSLT-II: Multi-institutional propensity score matched analysis |
| 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. © 2020 |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 232 |
| Issue: | 4 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2021-04-01 |
| Start Page: | 424 |
| End Page: | 431 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2020.11.014 |
| PUBMED: | 33316427 |
| PROVIDER: | scopus |
| PMCID: | PMC8764869 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 April 2021 -- Source: Scopus |
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