Results from this retrospective study showed no overall survival (OS) benefit for completion lymph node dissection (CLND) in patients with melanoma characterized by a positive sentinel lymph node. The findings from this study were published in the Journal of Surgical Oncology.
Although results from previous retrospective studies, as well as randomized clinical trials, have provided evidence for no significant OS difference for patients with melanoma with a positive sentinel lymph node undergoing either CLND or observation, there has been debate regarding whether some patient subsets exist who would benefit from CLND. This retrospective study was performed to reexamine the overall question, and to assess whether any clinicopathologic variables were predictive of a positive CLND.
Of the 953 patients with melanoma characterized by a positive sentinel lymph node included in the Sentinel Lymph Node Working Group database from 1994 to 2016, 87% and 13% did or did not undergo CLND, respectively. In the former subgroup, CLND was positive in 17% of patients and negative in 83% of patients. On multivariate analysis, significant predictors of a positive CLND were female gender (P =.048), lower extremity primary (P =.002), ulceration (P =.001), and total positive sentinel lymph nodes (P <.0001).
In the 86% of patients in the overall cohort for whom follow-up was available, disease recurrence occurred in 59% of patients with a positive CLND, 35% of patients with a negative CLND, and 38% of patients who received observation only (ie, no CLND). No significant differences in OS (P =.084) or melanoma-specific survival (P =.161) were observed when patients receiving CLND vs observation were compared. Similar rates of 5-year OS (64% vs 59%) and 5-year melanoma-specific survival (71% vs 66%) were observed for the 2 groups (CLND vs no CLND). However, when subgroups of CLND-positive and CLND-negative patients were compared, a significant difference in OS was observed in favor of the latter subgroup (P <.0001). Comparative rates of 5-year OS and 5-year melanoma-specific survival were 37% vs 70% and 49% and 76%, respectively (CLND-positive vs CLND-negative).
Possible study limitations included the relative short median follow-up of 29 months, as well as the possibility of selection bias with respect to the patients chosen to receive observation only.
In their concluding remarks, the authors stated that outstanding questions include whether CLND will improve survival in patients at higher risk of disease spread beyond the sentinel lymph node, and what could be the potential impact of leaving behind such disease in younger patients with melanoma.
- Klemen ND, Han G, Leong SP, et al. Completion lymphadenectomy for a positive sentinel node biopsy in melanoma patients is not associated with a survival benefit [published online March 18, 2019]. J Surg Oncol. doi: 10.1002/jso.25444