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Surveillance of Sen...
Surveillance of Sentinel Node-Positive Melanoma Patients with Reasons for Exclusion from MSLT-II: Multi-Institutional Propensity Score Matched Analysis
- Article/chapterEnglish2021
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Ovid Technologies (Wolters Kluwer Health),2021
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LIBRIS-ID:oai:gup.ub.gu.se/304389
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https://gup.ub.gu.se/publication/304389URI
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https://doi.org/10.1016/j.jamcollsurg.2020.11.014DOI
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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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.
Subject headings and genre
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Hughes, T. M.
(author)
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Dossett, L. A.
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Sun, J.
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Carr, M. J.
(author)
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Kirichenko, D. A.
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Sharma, A.
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Bartlett, E. K.
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Nijhuis, A. A. G.
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Thompson, J. F.
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Hieken, T. J.
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Kottschade, L.
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Downs, J.
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Gyorki, D. E.
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Gyorki, J. J.
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Stahlie, E.
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van Akkooi, A.
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Ollila, D. W.
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Frank, J.
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Song, Y.
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Karakousis, G.
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Moncrieff, M.
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Nobes, J.
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Vetto, J.
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Han, D.
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Farma, J.
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Deneve, J. L.
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Fleming, M. D.
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Perez, M.
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Baecher, K.
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Lowe, M.
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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)
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Mattsson, JanGothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för kirurgi,Institute of Clinical Sciences, Department of Surgery
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Lee, A. Y.
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Berman, R. S.
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Chai, H.
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Kroon, H. M.
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Teras, R. M.
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Teras, J.
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Farrow, N. E.
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Beasley, G. M.
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Hui, J. Y. C.
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Been, L.
(author)
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Kruijff, S.
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Boulware, D.
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Sarnaik, A. A.
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Sondak, V. K.
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Zager, J. S.
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Göteborgs universitetInstitutionen för kliniska vetenskaper, Avdelningen för kirurgi
(creator_code:org_t)
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In:Journal of the American College of Surgeons: Ovid Technologies (Wolters Kluwer Health)232:4, s. 424-4311072-7515
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Broman, K. K.
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Hughes, T. M.
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Dossett, L. A.
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Sun, J.
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Carr, M. J.
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Kirichenko, D. A ...
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show more...
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Sharma, A.
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Bartlett, E. K.
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Nijhuis, A. A. G ...
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Thompson, J. F.
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Hieken, T. J.
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Kottschade, L.
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Downs, J.
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Gyorki, D. E.
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Gyorki, J. J.
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Stahlie, E.
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van Akkooi, A.
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Ollila, D. W.
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Frank, J.
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Song, Y.
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Karakousis, G.
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Moncrieff, M.
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Nobes, J.
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Vetto, J.
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Han, D.
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Farma, J.
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Deneve, J. L.
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Fleming, M. D.
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Perez, M.
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Baecher, K.
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Lowe, M.
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Olofsson Bagge, ...
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Mattsson, Jan
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Lee, A. Y.
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Berman, R. S.
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Chai, H.
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Kroon, H. M.
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Teras, R. M.
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Teras, J.
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Farrow, N. E.
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Beasley, G. M.
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Hui, J. Y. C.
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Been, L.
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Kruijff, S.
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Boulware, D.
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Sarnaik, A. A.
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Sondak, V. K.
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Zager, J. S.
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Surgery
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University of Gothenburg