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Type: Journal article
Title: Surveillance of sentinel node-positive melanoma patients with reasons for exclusion from MLST-II: multi-institutional propensity score matched analysis
Author: Broman, K.K.
Hughes, T.M.
Dossett, L.A.
Sun, J.
Carr, M.
Kirichenko, D.A.
Sharma, A.
Bartlett, E.K.
Nijhuis, A.A.
Thompson, J.F.
Hieken, T.J.
Downs, J.
Gyorki, D.E.
Stahlie, E.
Akkooi, A.V.
Ollila, D.W.
Frank, J.
Song, Y.
Karakousis, G.
Moncrieff, M.
et al.
Citation: Journal of the American College of Surgeons, 2021; 232(4):424-431
Publisher: Elsevier BV
Issue Date: 2021
ISSN: 1072-7515
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Kristy K Broman, Tasha M Hughes, Lesly A Dossett, James Sun, Michael J Carr, Dennis A Kirichenko ... et al.
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).<h4>Conclusions</h4>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.
Keywords: International High-Risk Melanoma Consortium
Rights: © 2020 Published by Elsevier Inc. on behalf of theAmerican College of Surgeons. All rights reserved
DOI: 10.1016/j.jamcollsurg.2020.11.014
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