Impact of Completion Lymph Node Dissection on Patients with Positive Sentinel Lymph Node Biopsy in Melanoma

Lee, David Y.; Lau, Briana J.; Huynh, Kelly; Flaherty, Devin C.; Lee, Jihey; Stern, Stacey L.; O'Day, Steve J.; Foshag, Leland J.; Faries, Mark B.

doi:10.1016/j.jamcollsurg.2016.01.045

Cited by 29 publications

(26 citation statements)

References 41 publications

(36 reference statements)

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“…Retrospective series have produced varied results and are subject to a considerable risk of selection bias. 9–11 The findings of one prospective study were similar to those in our trial, but its size (483 patients underwent randomization) and most recent follow-up left enough statistical uncertainty to preclude definitive conclusions. 12 MSLT-II, in which 1939 patients underwent randomization with a median follow-up of 43 months, provided sufficient data to resolve the central question: no significant survival benefit was imparted by immediate completion lymph-node dissection among patients with sentinel-node metastases.…”

Section: Discussionsupporting

confidence: 70%

“…8 Results of retrospective evaluations of the usefulness of completion lymph-node dissection are inconclusive. 9–11 Available data from one prospective study do not suggest a benefit from immediate dissection, but this study is not sufficiently powered to rule out a clinically significant benefit. 12 In addition, in most patients, nodal disease is limited to the sentinel lymph node or nodes and is removed by means of biopsy.…”

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confidence: 92%

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Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma

et al. 2017

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BACKGROUND Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear. METHODS In an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Secondary end points included disease-free survival and the cumulative rate of nonsentinel-node metastasis. RESULTS Immediate completion lymph-node dissection was not associated with increased melanoma-specific survival among 1934 patients with data that could be evaluated in an intention-to-treat analysis or among 1755 patients in the per-protocol analysis. In the per-protocol analysis, the mean (±SE) 3-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86±1.3% and 86±1.2%, respectively; P=0.42 by the log-rank test) at a median follow-up of 43 months. The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68±1.7% and 63±1.7%, respectively; P=0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92±1.0% vs. 77±1.5%; P<0.001 by the log-rank test); these results must be interpreted with caution. Nonsentinel-node metastases, identified in 11.5% of the patients in the dissection group, were a strong, independent prognostic factor for recurrence (hazard ratio, 1.78; P=0.005). Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group. CONCLUSIONS Immediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases. (Funded by the National Cancer Institute and others; MSLT-II ClinicalTrials.gov number, NCT00297895.)

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Section: Discussionsupporting

confidence: 70%

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confidence: 92%

Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma

et al. 2017

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“…Some patients may benefit from lymphadenectomy as a therapeutic intervention, while for others the procedure may be solely diagnostic or even not beneficial in the longterm, depending on the characteristics of the primary tumour. 42,43,[50][51][52][53][54] Disease and site-specific studies will be necessary in dogs to delineate populations where intervention may be helpful…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of contrast‐enhanced computed tomography for assessment of mandibular and medial retropharyngeal lymph node metastasis in dogs with oral and nasal cancer

Skinner

Boston

Giglio

et al. 2018

Vet Comparative Oncology

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The diagnostic accuracy of contrast-enhanced CT for detection of cervical lymph node metastasis in dogs is unknown. The purpose of this retrospective, observational, diagnostic accuracy study was to assess the efficacy of CT for detection of mandibular and medial retropharyngeal lymph node metastasis in dogs. Histopathology of dogs with cancer of the head, CT and bilateral mandibular and medial retropharyngeal lymphadenectomy was reviewed. A single radiologist measured lymph nodes to derive short axis width and long-short axis ratios. Two blinded radiologists separately assessed lymph node margins, attenuation and contrast enhancement and each provided a final subjective interpretation of each node site as benign or neoplastic. Where radiologists' opinions differed, a consensus was reached. Sensitivity, specificity and accuracy were calculated for mandibular and medial retropharyngeal sites. Agreement between radiologists was assessed. Fisher's exact test and the Kruskal-Wallis H-test were used to assess associations between variables. Forty-one primary tumours were recorded in 40 dogs. Metastasis to mandibular or retropharyngeal lymph nodes occurred in 16 out of 40 dogs (43/160 nodes). Agreement between radiologists was almost perfect for margination, attenuation and enhancement, strong for interpretation of mandibular lymph node metastasis, and weak for interpretation of medial retropharyngeal lymph node metastasis. Sensitivity of CT was 12.5% and 10.5%, specificity was 91.1% and 96.7%, and accuracy was 67.5% and 76.3% for mandibular and medial retropharyngeal lymph nodes respectively. No individual CT findings were predictive of nodal metastasis. Given the low sensitivity of CT, this modality cannot be relied upon alone for assessment of cervical lymph node metastasis in dogs.

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“…A further five studies were excluded because they either had a missing intervention or control group, or the population of interest was not studied. After review, 15 articles were included in the qualitative synthesis ( Fig . ).…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of completion lymph node dissection in sentinel lymph node-positive melanoma

Angeles

Kang

Shirai

et al. 2019

British Journal of Surgery

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Background: The role of completion lymph node dissection (CLND) in patients with sentinel lymph node (SLN)-positive melanoma continues to be debated. This systematic review and meta-analysis evaluated survival and recurrence rate in these patients who underwent CLND, compared with observation.Methods: A comprehensive MEDLINE and Embase database search was performed for cohort studies and RCTs published between January 2000 and June 2017 that assessed the outcomes of CLND compared with observation in patients with SLN-positive melanoma. The primary outcome was survival and the secondary outcome was recurrence rate. Studies were assessed for quality using the Cochrane risk-of-bias tool for RCTs and Newcastle-Ottawa Scale for cohort studies. Pooled relative risk or hazard ratio with 95 per cent confidence intervals were calculated for each outcome. The extent of heterogeneity between studies was assessed with the I 2 test. The protocol was registered in PROSPERO (CRD42017070152).Results: Fifteen studies (13 cohort studies with 7868 patients and 2 RCTs with 2228 patients) were identified for qualitative synthesis. Thirteen studies remained for quantitative meta-analysis. Survival was similar in patients who underwent CLND and those who were observed (risk ratio (RR) for death 0⋅85, 95 per cent c.i. 0⋅71 to 1⋅02). The recurrence rate was also similar (RR 0⋅91, 0⋅79 to 1⋅05).Conclusion: Patients with SLN-positive melanoma do not have a significant benefit in survival or recurrence rate if they undergo CLND rather than observation.

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Impact of Completion Lymph Node Dissection on Patients with Positive Sentinel Lymph Node Biopsy in Melanoma

Cited by 29 publications

References 41 publications

Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma

Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma

Diagnostic accuracy of contrast‐enhanced computed tomography for assessment of mandibular and medial retropharyngeal lymph node metastasis in dogs with oral and nasal cancer

Meta-analysis of completion lymph node dissection in sentinel lymph node-positive melanoma

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