Skip to main content

Advertisement

SpringerLink
Log in

Survival Outcomes Following Lymph Node Biopsy in Thin Melanoma—A Propensity-Matched Analysis

  • Melanoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The use of sentinel lymph node biopsy in patients with T1 melanoma ≤ 1 mm has not been reported in a prospective clinical trial setting, so these clinical outcomes remain understudied. This study seeks to evaluate overall survival (OS) with and without lymph node biopsy (LNB) in patients with clinical T1N0M0 melanoma (0.5–1.0 mm).

Patients and Methods

Patients were identified using the National Cancer Data Base (2004–2012). After stratification into 0.5–0.7-mm and 0.8–1.0-mm groups, patients undergoing LNB were propensity score-matched 1:1 to patients not undergoing LNB. OS was compared using the Kaplan–Meier method and the stratified log-rank test.

Results

Resection was performed in 28,846 patients, and LNB in 14,028 (49%); 15,194 were included in propensity score-matched analysis. The LNB and no-LNB groups were well balanced on all studied covariates (standardized mean difference < 0.10). Among patients with tumors 0.5–0.7 mm, 5- and 10-year OS were 94.7% and 82.7%, respectively, for the LNB group compared with 94.3% and 84.4% for the no-LNB group (p = 0.35). Among patients with tumors 0.8–1.0 mm in thickness, 5- and 10-year OS were 93.9% and 81.6%, respectively, for the LNB group compared with 90.3% and 74.3% for the no-LNB group (p < 0.0001).

Conclusions

There was no difference in OS by LNB status in patients with lesions 0.5–0.7 mm, consistently with recommendations against its routine use in this group. In lesions 0.8–1.0 mm, receipt of LNB was associated with a clinically small but significant improvement in OS. Further study is warranted to better understand this outcome difference.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599–609.

    Article  CAS  Google Scholar 

  2. Wong SL, Faries MB, Kennedy EB, et al. Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology clinical practice guideline update. Ann Surg Oncol. 2018;25(2):356–77.

    Article  Google Scholar 

  3. Wong SL, Faries MB, Kennedy EB, et al. Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology clinical practice guideline update. J Clin Oncol. 2018;36(4):399–413.

    Article  Google Scholar 

  4. Coit DG, Andtbacka R, Anker CJ, et al. Melanoma, version 2.2013: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2013;11(4):395–407.

    Article  CAS  Google Scholar 

  5. Coit DG, Andtbacka R, Bichakjian CK, et al. Melanoma. J Natl Compr Canc Netw. 2009;7(3):250–75.

    Article  CAS  Google Scholar 

  6. Cormier JN, Xing Y, Ding M, et al. Population-based assessment of surgical treatment trends for patients with melanoma in the era of sentinel lymph node biopsy. J Clin Oncol. 2005;23(25):6054–62.

    Article  Google Scholar 

  7. Houghton A, Coit D, Bloomer W, et al. NCCN melanoma practice guidelines. National Comprehensive Cancer Network. Oncology (Williston Park). 1998;12(7A):153–77.

    CAS  Google Scholar 

  8. Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(6):472–92.

    Article  Google Scholar 

  9. Austin PC. The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments. Stat Med. 2014;33(7):1242–58.

    Article  Google Scholar 

  10. VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the e-value. Ann Intern Med. 2017;167(4):268–74.

    Article  Google Scholar 

  11. Sperry SM, Charlton ME, Pagedar NA. Association of sentinel lymph node biopsy with survival for head and neck melanoma: survival analysis using the SEER database. JAMA Otolaryngol Head Neck Surg. 2014;140(12):1101–9.

    Article  Google Scholar 

  12. Murtha TD, Han G, Han D. Predictors for use of sentinel node biopsy and the association with improved survival in melanoma patients who have nodal staging. Ann Surg Oncol. 2018;25(4):903–11.

    Article  Google Scholar 

  13. Boffa DJ, Rosen JE, Mallin K, et al. Using the National Cancer Database for outcomes research: a review. JAMA Oncol. 2017;3(12):1722–8.

    Article  Google Scholar 

  14. Cordeiro E, Gervais MK, Shah PS, Look Hong NJ, Wright FC. Sentinel lymph node biopsy in thin cutaneous melanoma: a systematic review and meta-analysis. Ann Surg Oncol. 2016;23(13):4178–88.

    Article  Google Scholar 

  15. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199–206.

    Article  Google Scholar 

Download references

Funding

P.A. Gimotty was supported in part by a grant from the National Cancer Institute, Specialized Programs of Research Excellence (SPORE), P50-CA174523. This study was reviewed and approved by the Institutional Review Board at the University of Pennsylvania (Protocol 828019).

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, University of Pennsylvania, Philadelphia, PA, USA

    Andrew J. Sinnamon MD, MSCE & Giorgos C. Karakousis MD

  2. Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA

    Andrew J. Sinnamon MD, MSCE, Phyllis A. Gimotty PhD & Yu-Xiao Yang MD, MSCE

Authors
  1. Andrew J. Sinnamon MD, MSCE
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Phyllis A. Gimotty PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giorgos C. Karakousis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yu-Xiao Yang MD, MSCE
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew J. Sinnamon MD, MSCE.

Ethics declarations

Disclosure

There are no financial conflicts to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sinnamon, A.J., Gimotty, P.A., Karakousis, G.C. et al. Survival Outcomes Following Lymph Node Biopsy in Thin Melanoma—A Propensity-Matched Analysis. Ann Surg Oncol 28, 1634–1641 (2021). https://doi.org/10.1245/s10434-020-08997-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-08997-3

Search

Navigation