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

Angeles, Christina V.; Kang, Ravinder; Shirai, Keisuke; Wong, Sandra L.

doi:10.1002/bjs.11149

Cited by 16 publications

(11 citation statements)

References 39 publications

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“…The value of our pooled study consists in scrupulous analysis of a large group of relevant studies and integrating them in such a way as to draw a unified conclusion. Furthermore, search strategy was wider as compared to previously attempted pooling of data [14,15,17,18,23,40].…”

Section: Discussionmentioning

confidence: 99%

Does It Really Pay-Off? Comparison of Lymphadenectomy versus Observational Approach in Skin Melanoma with Positive Sentinel Node Biopsy: Systematic Review and Meta-Analysis

Richter

Stefura

Macheta

et al. 2022

JCM

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The aim of this meta-analysis was to answer the question as to whether performing CLND (complete lymph node dissection) is necessary in every case of the melanoma patient after the positive SNB (sentinel node biopsy). To resolve doubts the authors reanalyzed previous articles and systematized the knowledge about the concerning medical problem. The databases such as PubMed, Scopus and Web of Science were screened to find articles that will be helpful to answer the controversial question if performing lymphadenectomy is crucial. The inclusion criteria consisted of randomized clinical trials, comparison of lymphadenectomy versus observation and positive sentinel node biopsy. After which, seven articles were examined. Authors analyzed parameters such as: recurrence, 3-year survival and 5-year survival. There was no relationship between the performance of CLND and melanoma recurrence (OR 1.04; 95% CI: 0.82–1.31; p = 0.75). However, no CLND group had higher 3-year survival (OR 1.22; 95% CI: 1.03–1.44; p = 0.02) and 5-year survival (OR 1.30; 95% CI: 1.19–1.85; p = 0.008). In conclusion, the observational approach to the melanoma patients with positive sentinel node biopsy is associated with comparable or slightly improved 3- and 5-year survival, then in case of routine lymphadenectomy. Although, in each melanoma patient a decision to perform or withhold lymphadenectomy should always be considered individually. Patients with low perioperative risk could be considered for surgical approach. The study was registered in PROSPERO and was assigned with the unique identifying number “CRD42021241272”.

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Section: Discussionmentioning

confidence: 99%

Does It Really Pay-Off? Comparison of Lymphadenectomy versus Observational Approach in Skin Melanoma with Positive Sentinel Node Biopsy: Systematic Review and Meta-Analysis

Richter

Stefura

Macheta

et al. 2022

JCM

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“…Indicators, not governors” (cited from [ 124 ]). Also, multiple meta-analyses of randomized controlled trials show no survival benefit of lymph node dissection compared to observation in melanoma [ 125 , 126 ]. This not only raises serious questions about today’s patient management, but also about our—lack of—understanding tumor biology.…”

Section: Tumor Microenvironment Remodeling and Adhesion Molecule Alterations Are Involved In Melanoma Cell Fate Motility And Migrationmentioning

confidence: 99%

Rethinking the biology of metastatic melanoma: a holistic approach

Vandyck

Hillen

Bosisio

et al. 2021

Cancer Metastasis Rev

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Over the past decades, melanoma-related mortality has remained nearly stable. The main reason is treatment failure of metastatic disease and the inherently linked knowledge gap regarding metastasis formation. In order to elicit invasion, melanoma cells manipulate the tumor microenvironment, gain motility, and adhere to the extracellular matrix and cancer-associated fibroblasts. Melanoma cells thereby express different cell adhesion molecules like laminins, integrins, N-cadherin, and others. Epithelial-mesenchymal transition (EMT) is physiological during embryologic development, but reactivated during malignancy. Despite not being truly epithelial, neural crest-derived malignancies like melanoma share similar biological programs that enable tumorigenesis, invasion, and metastasis. This complex phenomenon is termed phenotype switching and is intertwined with oncometabolism as well as dormancy escape. Additionally, it has been shown that primary melanoma shed exosomes that create a favorable premetastatic niche in the microenvironment of secondary organs and lymph nodes. Although the growing body of literature describes the aforementioned concepts separately, an integrative holistic approach is missing. Using melanoma as a tumor model, this review will shed light on these complex biological principles in an attempt to clarify the mechanistic metastatic pathways that dictate tumor and patient fate.

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“…Altogether thirteen studies were included in the quantitative pooled analysis, which showed similar survival in CLND group and observation group (risk ratio [RR] for death 0,85, 95% CI 0,71 to 1,02) and similar recurrence rate (RR 0,91, 0,79 to 1,05). [6] Table 1. compares DeCOG-SLT and MSLT-II studies.…”

Section: Fallen Dogma 1: All Sentinel Node Melanoma Metastasis Warrants Completion Lymphadenectomymentioning

confidence: 99%

Fallen dogmas – recent advances in locoregionally advanced melanoma

Wysocki¹,

Grela-Wojewoda

Jankowski³

2021

Polish Archives of Internal Medicine

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This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited, distributed under the same license, and used for noncommercial purposes only.

show abstract

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

Cited by 16 publications

References 39 publications

Does It Really Pay-Off? Comparison of Lymphadenectomy versus Observational Approach in Skin Melanoma with Positive Sentinel Node Biopsy: Systematic Review and Meta-Analysis

Does It Really Pay-Off? Comparison of Lymphadenectomy versus Observational Approach in Skin Melanoma with Positive Sentinel Node Biopsy: Systematic Review and Meta-Analysis

Rethinking the biology of metastatic melanoma: a holistic approach

Fallen dogmas – recent advances in locoregionally advanced melanoma

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