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

Broman, KK; Hughes, TM; Dossett, LA; Sun, J; Carr, MJ; Kirichenko, DA; Sharma, A; Bartlett, EK; Nijhuis, AAG; Thompson, JF; Hieken, TJ; Kottschade, L; Downs, J; Gyorki, DE; Stahlie, E; van Akkooi, A; Ollila, DW; Frank, J; Song, Y; Karakousis, G; Moncrieff, M; Nobes, J; Vetto, J; Han, D; Farma, J; Deneve, JL; Fleming, MD; Perez, M; Baecher, K; Lowe, M; Bagge, RO; Mattsson, J; Lee, AY; Berman, RS; Chai, H; Kroon, HM; Teras, RM; Teras, J; Farrow, NE; Beasley, GM; Hui, JYC; Been, L; Kruijff, S; Boulware, D; Sarnaik, AA; Sondak, VK; Zager, JS; International High-Risk Melanoma Consortium

Author(s): Broman, KK; Hughes, TM; Dossett, LA; Sun, J; Carr, MJ; Kirichenko, DA; Sharma, A; Bartlett, EK; Nijhuis, AAG; Thompson, JF; Hieken, TJ; Kottschade, L; Downs, J; Gyorki, DE; Stahlie, E; van Akkooi, A; Ollila, DW; Frank, J; Song, Y; Karakousis, G; Moncrieff, M; Nobes, J; Vetto, J; Han, D; Farma, J; Deneve, JL; Fleming, MD; Perez, M; Baecher, K; Lowe, M; Bagge, RO; Mattsson, J; Lee, AY; Berman, RS; Chai, H; Kroon, HM; Teras, RM; Teras, J; Farrow, NE; Beasley, GM; Hui, JYC; Been, L; Kruijff, S; Boulware, D; Sarnaik, AA; Sondak, VK; Zager, JS; International High-Risk Melanoma Consortium;
Details: Publication Year 2021-04,Volume 232,Issue #4,Page 424-431
Journal Title: Journal of the American College of Surgeons
Publication Type: Research article
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). 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.
Keywords: Adult; Aged; Chemotherapy, Adjuvant/statistics & numerical data; Clinical Trials, Phase III as Topic; Follow-Up Studies; Humans; Lymph Node Excision/standards/statistics & numerical data; Lymphatic Metastasis/*diagnosis/therapy; Male; Melanoma/diagnosis/mortality/pathology/*therapy; Middle Aged; Multicenter Studies as Topic; Neoplasm Recurrence, Local/*epidemiology; Neoplasm Staging; Patient Selection; Prognosis; Propensity Score; Radiotherapy, Adjuvant/statistics & numerical data; Randomized Controlled Trials as Topic; Sentinel Lymph Node/pathology; Sentinel Lymph Node Biopsy/statistics & numerical data; Skin Neoplasms/mortality/pathology/*therapy; Watchful Waiting/standards/*statistics & numerical data
Department(s): Surgical Oncology
PubMed ID: 33316427
Publisher's Version: https://doi.org/10.1016/j.jamcollsurg.2020.11.014
Open Access at Publisher's Site: https://doi.org/10.1016/j.jamcollsurg.2020.11.014
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-06-13 07:47:52

Last Modified: 2025-06-13 07:51:46