Regional Node Basin Recurrence in Melanoma Patients: More Common After Node Dissection for Macroscopic Rather than Clinically Occult Nodal Disease.

Autor: Uppal A; John Wayne Cancer Institute, Santa Monica, CA, USA., Stern S; John Wayne Cancer Institute, Santa Monica, CA, USA., Thompson JF; Melanoma Institute Australia and The University of Sydney, Sydney, NSW, Australia., Foshag L; John Wayne Cancer Institute, Santa Monica, CA, USA., Mizzollo N; University of Naples, Naples, Italy., Nieweg OE; Melanoma Institute Australia and The University of Sydney, Sydney, NSW, Australia., Hoekstra HJ; Universitair Medisch Centrum Groningen, Groningen, The Netherlands., Roses DF; New York University School of Medicine, New York, NY, USA., Sondak VK; H. Lee Moffitt Cancer Center, Tampa, FL, USA., Kashani-Sabet M; Sutter Health, San Francisco, CA, USA., Coventry BJ; Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia., Cochran AJ; University of California Los Angeles, Los Angeles, CA, USA., Fujita M; John Wayne Cancer Institute, Santa Monica, CA, USA., Sim-Shin M; University of California Los Angeles, Los Angeles, CA, USA., Elashoff D; University of California Los Angeles, Los Angeles, CA, USA., Elashoff RM; University of California Los Angeles, Los Angeles, CA, USA., Faries MB; Cedars-Sinai Medical Center, The Angeles Clinic and Research Institute, Los Angeles, CA, USA. mfaries@theangelesclinic.org.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2020 Jun; Vol. 27 (6), pp. 1970-1977. Date of Electronic Publication: 2019 Dec 20.
DOI: 10.1245/s10434-019-08086-0
Abstrakt: Background: Recommended treatment for patients with sentinel lymph node (SLN)-positive melanoma has recently changed. Randomized trials demonstrated equivalent survival with close observation versus completion lymph node dissection (CLND), but increased regional node recurrence. We evaluated factors related to in-basin nodal recurrence after lymphadenectomy (LND) for SLN-positive or macroscopic nodal metastases.
Methods: An institutional database and the first Multicenter Selective Lymphadenectomy Trial (MSLT-I) were analyzed independently. Exclusions were multiple primaries, multi-basin involvement, or in-transit metastases. Patient demographics, primary tumor thickness and ulceration, lymph nodes retrieved, and use of adjuvant radiotherapy were analyzed. Multivariate analyses were performed to determine factors predicting in-basin nodal recurrence (significance p ≤ 0.05).
Results: The retrospective cohort (577 patients) showed an in-basin failure rate of 6.6% after CLND for a positive SLN and 13.1% after LND for palpable disease (p = 0.001). This recurrence risk persisted after adjustment for patient, tumor, and LND factors [hazard ratio (HR) 2.32; p = 0.004]. In the MSLT-I cohort (326 patients), the failure rate after CLND following SLNB was 6.2%, but 10.1% after LND for palpable recurrence in observation patients. After adjustment for other factors, macroscopic disease was associated with an increased risk of recurrence after LND (HR 2.24; p = 0.05).
Conclusion: After LND for melanoma, in-basin recurrence is infrequent, but a clinically significant fraction will fail. Failure is less likely if dissection is performed for clinically occult disease. Further research is warranted to evaluate the long-term regional control and quality of life associated with nodal basin observation, which has now become standard practice.
Databáze: MEDLINE
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