Fax: (011) 39 049651891
Early (sentinel lymph node biopsy-guided) versus delayed lymphadenectomy in melanoma patients with lymph node metastases†‡
Personal Experience and Literature Meta-Analysis
Version of Record online: 11 JAN 2010
Copyright © 2010 American Cancer Society
Volume 116, Issue 5, pages 1201–1209, 1 March 2010
How to Cite
Pasquali, S., Mocellin, S., Campana, L. G., Bonandini, E., Montesco, M. C., Tregnaghi, A., Del Fiore, P., Nitti, D. and Rossi, C. R. (2010), Early (sentinel lymph node biopsy-guided) versus delayed lymphadenectomy in melanoma patients with lymph node metastases. Cancer, 116: 1201–1209. doi: 10.1002/cncr.24852
See editorial on pages 1150-2, this issue.
We thank Dr. Loris Bertazza for his help with figures.
- Issue online: 18 FEB 2010
- Version of Record online: 11 JAN 2010
- Manuscript Revised: 5 JUN 2009
- Manuscript Accepted: 5 JUN 2009
- Manuscript Received: 4 APR 2009
- sentinel lymph node biopsy;
- radical lymph node dissection;
- early lymph node dissection;
- delayed lymph node dissection;
- lymph node observation;
It is debated whether patients with melanoma who undergo lymphadenectomy after a positive sentinel lymph node (SN) biopsy (SNB) have a better prognosis compared with patients who are treated for clinically evident disease.
The records of 190 patients with cutaneous melanoma who underwent radical lymph node dissection after a positive SNB (completion lymph node dissection [CLND]; n = 100) or who had clinically evident lymph node metastasis (therapeutic lymph node dissection [TLND]; n = 90) were analyzed. Moreover, the MEDLINE, EMBASE, and Cochrane databases were searched for studies that investigated the survival impact of SNB-guided CLND compared with TLND for clinically evident disease. Standard meta-analysis methods were used to calculate the overall treatment effect across eligible studies.
In the authors' series, tumor characteristics did not differ significantly between patients who underwent CLND and those who underwent TLND. After a median follow-up of 52.6 months, the 5-year overall survival rate did not differ significantly between CLND patients and TLND patients (68.9% vs 50.4%, respectively; log-rank test; P = .17). In contrast, a meta-analysis of 6 studies (n = 2633) that addressed this issue (including the authors' own series) indicated that there was a significantly higher risk of death for patients who underwent TLND compared with that for patients who underwent CLND (hazard ratio, 1.60; 95% confidence interval, 1.28-2.00; P < .0001).
Although no significant survival difference was observed in either series, the pooling of summary data from all the studies that dealt with this issue suggested that SNB-guided CLND is associated with a significantly better outcome compared with TLND for clinically evident lymph node disease. Cancer 2010. © 2010 American Cancer Society.