Management of the positive sentinel lymph node in the post-MSLT-II era.

Autor: Bredbeck BC; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan., Mubarak E; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan., Zubieta DG; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan., Tesorero R; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan., Holmes AR; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan., Dossett LA; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.; Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan., VanKoevering KK; Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan.; Department of Otolaryngology, Michigan Medicine, Ann Arbor, Michigan., Durham AB; Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan.; Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan., Hughes TM; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.; Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2020 Dec; Vol. 122 (8), pp. 1778-1784. Date of Electronic Publication: 2020 Sep 06.
DOI: 10.1002/jso.26200
Abstrakt: Background and Objectives: The publication of MSLT-II shifted recommendations for management of sentinel lymph node biopsy positive (SLNB+) melanoma to favor active surveillance. We examined trends in immediate completion lymph node dissection (CLND) following publication of MSLT-II.
Methods: Using a prospective melanoma database at a high-volume center, we identified a cohort of consecutive SLNB+ patients from July 2016 to April 2019. Patient and disease characteristics were analyzed with multivariate logistic regression to examine factors associated with CLND.
Results: Two hundred and thirty-five patients were included for analysis. CLND rates were 67%, 33%, and 26% for the year before, year after, and second-year following MSLT-II. Factors associated with undergoing CLND included primary located in the head and neck (59% vs 33%, P = .003 and odds ratio [OR], 5.22, P = .002) and higher sentinel node tumor burden (43% vs 10% for tumor burden ≥0.1 mm, P < .001 and OR, 8.64, P = .002).
Conclusions: Rates of CLND in SLNB+ melanoma decreased dramatically, albeit not uniformly, following MSLT-II. Factors that increased the likelihood of immediate CLND were primary tumor located in the head and neck and high sentinel node tumor burden. These groups were underrepresented in MSLT-II, suggesting that clinicians are wary of implementing active surveillance recommendations for patients perceived as higher risk.
(© 2020 Wiley Periodicals LLC.)
Databáze: MEDLINE
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