Prognostic outcomes of immediate complete lymph node dissection versus observation in patients with acral melanoma of the sole with sentinel node metastasis: a retrospective, multicenter study.
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История · было → стало
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Inoue Sadao, Koizumi Shigeru, Yamazaki Naoya, Ichigozaki Yuki, Kitagawa Hiroshi, Kiniwa Yukiko, Sato Sayuri, Takai Toshihiro, Doi Reiichi, Ito Takamichi, Yasuda Masahito, Kuwatsuka Yutaka, Maekawa Takeo, Asai Jun, Miyagawa Takuya, Matsushita Shigeto, Funakoshi Takeru, Yamamoto Yosuke, Inozume Takashi, Kishi Akiko, Takenouchi Tatsuya, Kokubu Hiraku, Ito Shusaku, Umeda Yoshiyasu, Yamamoto Yuki, Ishizuki Shoichiro, Iino Shiro, Uchi Hiroshi, Nakagawa Tomoe, Inafuku Kazuhiro, Haga Takahiro, Kaneko Takahide, Nakagawa Masahiro, Kamiya Hideki, Arima Masaru, Hoashi Toshihiko, Hiura Azusa, Kanazawa Nobuo, Manabe Keiko, Ishikawa Masashi, Asagoe Kenji, Iwasawa Utsugi, Kadono Takafumi, Hatta Naohito, Minami Shoichiro, Nakano Eiji, Ogata Dai, Fukushima Satoshi, Uhara Hisashi, Nakama Kenta, Komori Takaya, Igawa Ken, Nakamura Yasuhiro
Аннотация
METHODS: This retrospective, multicenter study included 154 patients (CLND: 90, OBS: 64) with stage III sole AM with positive SN, across 44 Japanese institutions. Recurrence-free survival (RFS), distant metastasis-free survival (DMFS), regional metastasis-free survival (RMFS), and overall survival (OS) were compared between the two groups. Cox multivariable analysis and propensity score matching (PSM) were performed to adjust for potential confounders.
RESULTS: With a median follow-up of 3.9 years, non-significant differences were observed in RFS, DMFS, RMFS, or OS between the CLND and OBS groups (P = 0.33, 0.32, 0.08, and 0.21, respectively). Cox multivariable analysis identified N3a nodal stage as an independent negative factor for OS (HR: 2.6, P = 0.02), whereas CLND and other variables were not associated. After PSM, 92 (46 each) were matched. RFS and DMFS remained comparable (P = 0.16 and 0.19), with a non-significant trend toward improved RMFS in the CLND group (P = 0.08), and no difference in OS (P = 0.14).
CONCLUSIONS: Immediate CLND did not provide a survival advantage over OBS in patients with stage III sole AM and positive SN. These findings do not support the routine use of CLND in this population. Trial registration Not applicable.