Surveillance of Sentinel Node-Positive Melanoma Patients with Reasons for Exclusion from MSLT-II: Multi-Institutional Propensity Score Matched Analysis.
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Broman Kristy K, Hughes Tasha M, Dossett Lesly A, Sun James, Carr Michael J, Kirichenko Dennis A, Sharma Avinash, Bartlett Edmund K, Nijhuis Amanda Ag, Thompson John F, Hieken Tina J, Kottschade Lisa, Downs Jennifer, Gyorki David E, Stahlie Emma, van Akkooi Alexander, Ollila David W, Frank Jill, Song Yun, Karakousis Giorgos, Moncrieff Marc, Nobes Jenny, Vetto John, Han Dale, Farma Jeffrey, Deneve Jeremiah L, Fleming Martin D, Perez Matthew, Baecher Kirsten, Lowe Michael, Bagge Roger Olofsson, Mattsson Jan, Lee Ann Y, Berman Russell S, Chai Harvey, Kroon Hidde M, Teras Roland M, Teras Juri, Farrow Norma E, Beasley Georgia M, Hui Jane Yc, Been Lukas, Kruijff Schelto, Boulware David, Sarnaik Amod A, Sondak Vernon K, Zager Jonathan S, International High-Risk Melanoma Consortium
Аннотация
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.