Waiving Subsequent Complete Lymph Node Dissection in Melanoma Patients with Positive Sentinel Lymph Node Does Not Result in Worse Outcome on 20-Year Analysis

Complete lymph node dissection (CLND) following positive sentinel lymph node (SLN) biopsy has been the standard of care for decades. We aimed to study melanoma patients with an emphasis on the outcome of patients with versus without CLND following positive SLN biopsy. SLN-positive patients with or w...

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Autores principales:	Laura Susok, Celine Nick, Jürgen C. Becker, Falk G. Bechara, Markus Stücker, Waldemar Uhl, Thilo Gambichler
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	malignant melanoma sentinel lymph node biopsy complete lymph node dissection lymphadenectomy melanoma-specific survival micrometastasis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/94f62d73aecf4a97b396341455b6ea06
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spelling	oai:doaj.org-article:94f62d73aecf4a97b396341455b6ea062021-11-11T15:31:10ZWaiving Subsequent Complete Lymph Node Dissection in Melanoma Patients with Positive Sentinel Lymph Node Does Not Result in Worse Outcome on 20-Year Analysis10.3390/cancers132154252072-6694https://doaj.org/article/94f62d73aecf4a97b396341455b6ea062021-10-01T00:00:00Zhttps://www.mdpi.com/2072-6694/13/21/5425https://doaj.org/toc/2072-6694Complete lymph node dissection (CLND) following positive sentinel lymph node (SLN) biopsy has been the standard of care for decades. We aimed to study melanoma patients with an emphasis on the outcome of patients with versus without CLND following positive SLN biopsy. SLN-positive patients with or without CLND were compared regarding important prognostic clinical and histological characteristics. Ten-year and 20-year survival curves for melanoma relapse and melanoma-specific survival (MSS) were determined by the Kaplan-Meier method and Cox proportional-hazards regression. We studied 258 patients who had micrometastases in their SLN biopsy. CLND was performed in 209 of 258 patients (81%). Hence, in 49 of 258 patients (19%) with SLN micrometastases, CLND was not performed. These patients did not significantly (<i>p</i> > 0.05) differ from patients with CLND in regard to age, gender, tumor thickness, tumor ulceration, capsule infiltration of SLN, or invasion level of SLN. On 10-year analysis, we did not observe a significantly increased risk for melanoma relapse and worse in MSS in patients who did not undergo CLND (hazard ratio: 1.1 (95% CI 0.67 to 1.7) and 1.1 (95% CI 0.67 to 1.9), respectively). On 20-year survival analysis, we confirmed that the risk of melanoma relapse and impaired MSS does not significantly increase in patients without CLND (hazard ratio: 1.2 (95% CI 0.8 to 1.9) and 1.3 (95% CI 0.8 to 2.3), respectively). On 10-year as well as 20-year multivariable follow-up analysis (including several important prognostic factors), Cox proportional-hazards regression showed that the status of CLND did not remain in the regression model (<i>p</i> > 0.1). Our 10-year data give conclusive support to previous investigations indicating that waiving CLND in patients with SLN micrometastases does not affect MSS. More importantly, our long-term follow-up data confirm for the first time the 10-year survival data of previous investigations.Laura SusokCeline NickJürgen C. BeckerFalk G. BecharaMarkus StückerWaldemar UhlThilo GambichlerMDPI AGarticlemalignant melanomasentinel lymph node biopsycomplete lymph node dissectionlymphadenectomymelanoma-specific survivalmicrometastasisNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancers, Vol 13, Iss 5425, p 5425 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	malignant melanoma sentinel lymph node biopsy complete lymph node dissection lymphadenectomy melanoma-specific survival micrometastasis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	malignant melanoma sentinel lymph node biopsy complete lymph node dissection lymphadenectomy melanoma-specific survival micrometastasis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Laura Susok Celine Nick Jürgen C. Becker Falk G. Bechara Markus Stücker Waldemar Uhl Thilo Gambichler Waiving Subsequent Complete Lymph Node Dissection in Melanoma Patients with Positive Sentinel Lymph Node Does Not Result in Worse Outcome on 20-Year Analysis
description	Complete lymph node dissection (CLND) following positive sentinel lymph node (SLN) biopsy has been the standard of care for decades. We aimed to study melanoma patients with an emphasis on the outcome of patients with versus without CLND following positive SLN biopsy. SLN-positive patients with or without CLND were compared regarding important prognostic clinical and histological characteristics. Ten-year and 20-year survival curves for melanoma relapse and melanoma-specific survival (MSS) were determined by the Kaplan-Meier method and Cox proportional-hazards regression. We studied 258 patients who had micrometastases in their SLN biopsy. CLND was performed in 209 of 258 patients (81%). Hence, in 49 of 258 patients (19%) with SLN micrometastases, CLND was not performed. These patients did not significantly (<i>p</i> > 0.05) differ from patients with CLND in regard to age, gender, tumor thickness, tumor ulceration, capsule infiltration of SLN, or invasion level of SLN. On 10-year analysis, we did not observe a significantly increased risk for melanoma relapse and worse in MSS in patients who did not undergo CLND (hazard ratio: 1.1 (95% CI 0.67 to 1.7) and 1.1 (95% CI 0.67 to 1.9), respectively). On 20-year survival analysis, we confirmed that the risk of melanoma relapse and impaired MSS does not significantly increase in patients without CLND (hazard ratio: 1.2 (95% CI 0.8 to 1.9) and 1.3 (95% CI 0.8 to 2.3), respectively). On 10-year as well as 20-year multivariable follow-up analysis (including several important prognostic factors), Cox proportional-hazards regression showed that the status of CLND did not remain in the regression model (<i>p</i> > 0.1). Our 10-year data give conclusive support to previous investigations indicating that waiving CLND in patients with SLN micrometastases does not affect MSS. More importantly, our long-term follow-up data confirm for the first time the 10-year survival data of previous investigations.
format	article
author	Laura Susok Celine Nick Jürgen C. Becker Falk G. Bechara Markus Stücker Waldemar Uhl Thilo Gambichler
author_facet	Laura Susok Celine Nick Jürgen C. Becker Falk G. Bechara Markus Stücker Waldemar Uhl Thilo Gambichler
author_sort	Laura Susok
title	Waiving Subsequent Complete Lymph Node Dissection in Melanoma Patients with Positive Sentinel Lymph Node Does Not Result in Worse Outcome on 20-Year Analysis
title_short	Waiving Subsequent Complete Lymph Node Dissection in Melanoma Patients with Positive Sentinel Lymph Node Does Not Result in Worse Outcome on 20-Year Analysis
title_full	Waiving Subsequent Complete Lymph Node Dissection in Melanoma Patients with Positive Sentinel Lymph Node Does Not Result in Worse Outcome on 20-Year Analysis
title_fullStr	Waiving Subsequent Complete Lymph Node Dissection in Melanoma Patients with Positive Sentinel Lymph Node Does Not Result in Worse Outcome on 20-Year Analysis
title_full_unstemmed	Waiving Subsequent Complete Lymph Node Dissection in Melanoma Patients with Positive Sentinel Lymph Node Does Not Result in Worse Outcome on 20-Year Analysis
title_sort	waiving subsequent complete lymph node dissection in melanoma patients with positive sentinel lymph node does not result in worse outcome on 20-year analysis
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/94f62d73aecf4a97b396341455b6ea06
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Waiving Subsequent Complete Lymph Node Dissection in Melanoma Patients with Positive Sentinel Lymph Node Does Not Result in Worse Outcome on 20-Year Analysis

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