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Surveillance of sentinel node-positive melanoma patients with reasons for exclusion from MLST-II: multi-institutional propensity score matched analysis

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dc.contributor.authorBroman, K.K.
dc.contributor.authorHughes, T.M.
dc.contributor.authorDossett, L.A.
dc.contributor.authorSun, J.
dc.contributor.authorCarr, M.
dc.contributor.authorKirichenko, D.A.
dc.contributor.authorSharma, A.
dc.contributor.authorBartlett, E.K.
dc.contributor.authorNijhuis, A.A.
dc.contributor.authorThompson, J.F.
dc.contributor.authorHieken, T.J.
dc.contributor.authorDowns, J.
dc.contributor.authorGyorki, D.E.
dc.contributor.authorStahlie, E.
dc.contributor.authorAkkooi, A.V.
dc.contributor.authorOllila, D.W.
dc.contributor.authorFrank, J.
dc.contributor.authorSong, Y.
dc.contributor.authorKarakousis, G.
dc.contributor.authorMoncrieff, M.
dc.contributor.authoret al.
dc.date.issued2021
dc.description.abstractBackground 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.
dc.description.statementofresponsibilityKristy K Broman, Tasha M Hughes, Lesly A Dossett, James Sun, Michael J Carr, Dennis A Kirichenko ... et al.
dc.identifier.citationJournal of the American College of Surgeons, 2021; 232(4):424-431
dc.identifier.doi10.1016/j.jamcollsurg.2020.11.014
dc.identifier.issn1072-7515
dc.identifier.issn1879-1190
dc.identifier.orcidKroon, H.M. [0000-0002-8923-7527]
dc.identifier.urihttp://hdl.handle.net/2440/130822
dc.language.isoen
dc.publisherElsevier BV
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/APP1093017
dc.rights© 2020 Published by Elsevier Inc. on behalf of theAmerican College of Surgeons. All rights reserved
dc.source.urihttps://doi.org/10.1016/j.jamcollsurg.2020.11.014
dc.subjectInternational High-Risk Melanoma Consortium
dc.titleSurveillance of sentinel node-positive melanoma patients with reasons for exclusion from MLST-II: multi-institutional propensity score matched analysis
dc.typeJournal article
pubs.publication-statusPublished

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