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  • Broman, K. K. (author)

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

  • Article/chapterEnglish2021

Publisher, publication year, extent ...

  • Ovid Technologies (Wolters Kluwer Health),2021

Numbers

  • LIBRIS-ID:oai:gup.ub.gu.se/304389
  • https://gup.ub.gu.se/publication/304389URI
  • https://doi.org/10.1016/j.jamcollsurg.2020.11.014DOI

Supplementary language notes

  • Language:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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. Crown Copyright (C) 2020 Published by Elsevier Inc. on behalf of the American College of Surgeons. All rights reserved.

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  • Hughes, T. M. (author)
  • Dossett, L. A. (author)
  • Sun, J. (author)
  • Carr, M. J. (author)
  • Kirichenko, D. A. (author)
  • Sharma, A. (author)
  • Bartlett, E. K. (author)
  • Nijhuis, A. A. G. (author)
  • Thompson, J. F. (author)
  • Hieken, T. J. (author)
  • Kottschade, L. (author)
  • Downs, J. (author)
  • Gyorki, D. E. (author)
  • Gyorki, J. J. (author)
  • Stahlie, E. (author)
  • van Akkooi, A. (author)
  • Ollila, D. W. (author)
  • Frank, J. (author)
  • Song, Y. (author)
  • Karakousis, G. (author)
  • Moncrieff, M. (author)
  • Nobes, J. (author)
  • Vetto, J. (author)
  • Han, D. (author)
  • Farma, J. (author)
  • Deneve, J. L. (author)
  • Fleming, M. D. (author)
  • Perez, M. (author)
  • Baecher, K. (author)
  • Lowe, M. (author)
  • Olofsson Bagge, Roger,1978Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för kirurgi,Institute of Clinical Sciences, Department of Surgery(Swepub:gu)xoloro (author)
  • Mattsson, JanGothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för kirurgi,Institute of Clinical Sciences, Department of Surgery (author)
  • Lee, A. Y. (author)
  • Berman, R. S. (author)
  • Chai, H. (author)
  • Kroon, H. M. (author)
  • Teras, R. M. (author)
  • Teras, J. (author)
  • Farrow, N. E. (author)
  • Beasley, G. M. (author)
  • Hui, J. Y. C. (author)
  • Been, L. (author)
  • Kruijff, S. (author)
  • Boulware, D. (author)
  • Sarnaik, A. A. (author)
  • Sondak, V. K. (author)
  • Zager, J. S. (author)
  • Göteborgs universitetInstitutionen för kliniska vetenskaper, Avdelningen för kirurgi (creator_code:org_t)

Related titles

  • In:Journal of the American College of Surgeons: Ovid Technologies (Wolters Kluwer Health)232:4, s. 424-4311072-7515

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