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https://hdl.handle.net/2440/130822
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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 1879-1190 |
Statement of Responsibility: | 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 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/APP1093017 |
Published version: | http://dx.doi.org/10.1016/j.jamcollsurg.2020.11.014 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
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