Is there a therapeutic benefit of complete lymph node dissection in melanoma patients with low tumor burden in the sentinel node?

被引:28
作者
Satzger, Imke [1 ]
Meier, Andre [1 ]
Zapf, Antonia [2 ]
Niebuhr, Margarete [1 ]
Kapp, Alexander [1 ]
Gutzmer, Ralf [1 ]
机构
[1] Hannover Med Sch, Dept Dermatol & Allergy, D-30625 Hannover, Germany
[2] Univ Med Gottingen, Inst Biostat, Gottingen, Germany
关键词
complete lymph node dissection; histology; melanoma; prognosis; sentinel lymph node; CUTANEOUS MELANOMA; PROGNOSTIC-SIGNIFICANCE; POSITIVE MELANOMA; S-CLASSIFICATION; BIOPSY; LYMPHADENECTOMY; CRITERIA; MULTICENTER; SURVIVAL; DISEASE;
D O I
10.1097/CMR.0000000000000081
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
In the case of a positive sentinel lymph node (SLN), melanoma patients are recommended to proceed to complete lymph node dissection (CLND). However, CLND for SLN-positive patients - especially with minimal tumor burden in SLN - is becoming more controversial. We analyzed the clinical course of 305 SLN-positive patients with a mean follow-up of 51.1 months by Kaplan-Meier analyses. Overall, 58/305 (17%) patients did not undergo CLND. These were compared with a matched selection of 58 comparable patients who underwent CLND. Moreover, 106/305 patients with minimal tumor burden in SLN (<0.1 mm diameter of the largest tumor deposit) were analyzed separately. Of these 106 patients, 34 did not undergo CLND, whereas 72/106 patients were treated by CLND. In the matched groups, the CLND group and the non-CLND group did not differ significantly with respect to clinical characteristics, characteristics of the primary melanoma, and histopathological parameters of SLN. There were no differences in recurrence-free survival (P = 0.765) and overall survival (P = 0.844). The total number of regional lymph node metastases and time to regional lymph node metastases were not significantly higher for non-CLND patients. The subgroup of patients with minimal tumor burden in SLN also did not benefit significantly from CLND. In our analyses from a single German center, we could not find any evidence for a therapeutic survival benefit for CLND after positive SLN. However, future prospective randomized trials should confirm these data. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
引用
收藏
页码:454 / 461
页数:8
相关论文
共 27 条
[1]   Final Version of 2009 AJCC Melanoma Staging and Classification [J].
Balch, Charles M. ;
Gershenwald, Jeffrey E. ;
Soong, Seng-jaw ;
Thompson, John F. ;
Atkins, Michael B. ;
Byrd, David R. ;
Buzaid, Antonio C. ;
Cochran, Alistair J. ;
Coit, Daniel G. ;
Ding, Shouluan ;
Eggermont, Alexander M. ;
Flaherty, Keith T. ;
Gimotty, Phyllis A. ;
Kirkwood, John M. ;
McMasters, Kelly M. ;
Mihm, Martin C., Jr. ;
Morton, Donald L. ;
Ross, Merrick I. ;
Sober, Arthur J. ;
Sondak, Vernon K. .
JOURNAL OF CLINICAL ONCOLOGY, 2009, 27 (36) :6199-6206
[2]   Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma [J].
Balch, CM ;
Buzaid, AC ;
Soong, SJ ;
Atkins, MB ;
Cascinelli, N ;
Coit, DG ;
Fleming, ID ;
Gershenwald, JE ;
Houghton, A ;
Kirkwood, JM ;
McMasters, KM ;
Mihm, MF ;
Morton, DL ;
Reintgen, DS ;
Ross, MI ;
Sober, A ;
Thompson, JA ;
Thompson, JF .
JOURNAL OF CLINICAL ONCOLOGY, 2001, 19 (16) :3635-3648
[3]   Guidelines of care for the management of primary cutaneous melanoma [J].
Bichakjian, Christopher K. ;
Halpern, Allan C. ;
Johnson, Timothy M. ;
Hood, Antoinette Foote ;
Grichnik, James M. ;
Swetter, Susan M. ;
Tsao, Hensin ;
Barbosa, Victoria Holloway ;
Chuang, Tsu-Yi ;
Duvic, Madeleine ;
Ho, Vincent C. ;
Sober, Arthur J. ;
Beutner, Karl R. ;
Bhushan, Reva ;
Begolka, Wendy Smith .
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, 2011, 65 (05) :1032-1047
[4]   The amount of metastatic melanoma in a sentinel lymph node: Does it have prognostic significance? [J].
Carlson, GW ;
Murray, DR ;
Lyles, RH ;
Staley, CA ;
Hestley, A ;
Cohen, C .
ANNALS OF SURGICAL ONCOLOGY, 2003, 10 (05) :575-581
[5]   The Impact on Morbidity and Length of Stay of Early Versus Delayed Complete Lymphadenectomy in Melanoma: Results of the Multicenter Selective Lymphadenectomy Trial (I) [J].
Faries, Mark B. ;
Thompson, John F. ;
Cochran, Alistair ;
Elashoff, Robert ;
Glass, Edwin C. ;
Mozzillo, Nicola ;
Nieweg, Omgo E. ;
Roses, Daniel F. ;
Hoekstra, Harold J. ;
Karakousis, Constantine P. ;
Reintgen, Douglas S. ;
Coventry, Brendon J. ;
Wang, He-Jing ;
Morton, Donald L. .
ANNALS OF SURGICAL ONCOLOGY, 2010, 17 (12) :3324-3329
[6]   S-classification of sentinel lymph node biopsy predicts the results of complete regional lymph node dissection [J].
Fink, AM ;
Weihsengruber, F ;
Spangl, B ;
Feichtinger, H ;
Lilgenau, N ;
Rappersberger, K ;
Jurecka, W ;
Steiner, A .
MELANOMA RESEARCH, 2005, 15 (04) :267-271
[7]   Diagnosis and treatment of melanoma: European consensus-based interdisciplinary guideline [J].
Garbe, Claus ;
Peris, Ketty ;
Hauschild, Axel ;
Saiag, Philippe ;
Middleton, Mark ;
Spatz, Alain ;
Grob, Jean-Jacques ;
Malvehy, Josep ;
Newton-Bishop, Julia ;
Stratigos, Alexander ;
Pehamberger, Hubert ;
Eggermont, Alexander .
EUROPEAN JOURNAL OF CANCER, 2010, 46 (02) :270-283
[8]   Histological features of melanoma sentinel lymph node metastases associated with status of the completion lymphadenectomy and rate of subsequent relapse [J].
Govindarajan, Anand ;
Ghazarian, Danny M. ;
McCready, David R. ;
Leong, Wey L. .
ANNALS OF SURGICAL ONCOLOGY, 2007, 14 (02) :906-912
[9]   The Number of Lymph Nodes Involved with Metastatic Disease Does Not Affect Outcome in Melanoma Patients as Long as All Disease Is Confined to the Sentinel Lymph Node [J].
Jakub, James W. ;
Huebner, Marianne ;
Shivers, Steve ;
Nobo, Christopher ;
Puleo, Christopher ;
Harmsen, William S. ;
Reintgen, Douglas S. .
ANNALS OF SURGICAL ONCOLOGY, 2009, 16 (08) :2245-2251
[10]   Outcome of Patients with a Positive Sentinel Lymph Node who do not Undergo Completion Lymphadenectomy [J].
Kingham, T. Peter ;
Panageas, Katherine S. ;
Ariyan, Charlotte E. ;
Busam, Klaus J. ;
Brady, Mary Sue ;
Coit, Daniel G. .
ANNALS OF SURGICAL ONCOLOGY, 2010, 17 (02) :514-520