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Assessment of Frailty Can Guide Decision Making for Utilization of Sentinel Lymph Node Biopsy in Patients with Thick Melanoma

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

Abstract

Background

Sentinel lymph node biopsy (SLNB) is often omitted in selected patients with advanced primary melanoma, although the justification/criteria for omission have been debated.

Objective

We sought to determine whether assessment of frailty could serve as an objective marker to guide selection for SLNB in patients with advanced primary melanoma.

Methods

Patients presenting with clinical stage IIC (ulcerated, > 4 mm Breslow thickness) cutaneous melanoma from January 1999 through June 2019 were included. Frailty was assessed using the Memorial Sloan Kettering Frailty Index (MSK FI), a composite score of functional status and medical comorbidities. Five-year melanoma-specific survival (MSS) and overall survival (OS) were estimated using Cox regression, and predictors of OS were identified using competing risk models.

Results

MSS did not differ between patients who did (n = 451) or did not undergo SLNB (n = 179) [63.2% vs. 65.0%, p = 0.14]; however, omission of SLNB was associated with decreased 5-year OS (29% vs. 44%, p < 0.001). In a multivariable competing risk model, selection for SLNB omission was an independent predictor of death from non-melanoma causes (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.2–2.3, p < 0.001). After incorporation of the MSK FI score into the multivariable model in this subset, MSK FI (HR 2.4, 95% CI 1.5–4.1, p < 0.001), but not SLNB omission, was an independent predictor of poorer OS.

Conclusion

We observed worse OS in patients with thick melanoma selected not to undergo SLNB, which was attributed to death due to non-melanoma causes. Formal assessment of frailty may provide an objective prognostic measure to guide selective use of SLNB in these patients.

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Acknowledgment

The authors would like to acknowledge Jessica Moore for her editorial support in the production of this paper.

Funding

This research was supported in part by NIH/NCI Cancer Center Support Grant P30 CA008748 to the institution.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Avinash S. Sharma MD, MPH, Danielle M. Bello MD, Charlotte E. Ariyan MD, Mary Sue Brady MD, Daniel G. Coit MD & Edmund K. Bartlett MD

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jessica R. Flynn BS, Katherine S. Panageas DrPH & Amy L. Tin MA

  3. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Armin Shahrokni MD, MPH

  4. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    Armin Shahrokni MD, MPH

  5. Department of Surgery, Weill Cornell Medical College, New York, NY, USA

    Charlotte E. Ariyan MD, Mary Sue Brady MD, Daniel G. Coit MD & Edmund K. Bartlett MD

Authors
  1. Avinash S. Sharma MD, MPH
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  2. Jessica R. Flynn BS
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  3. Katherine S. Panageas DrPH
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  4. Armin Shahrokni MD, MPH
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  5. Amy L. Tin MA
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  6. Danielle M. Bello MD
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  7. Charlotte E. Ariyan MD
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  8. Mary Sue Brady MD
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  9. Daniel G. Coit MD
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  10. Edmund K. Bartlett MD
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Corresponding author

Correspondence to Edmund K. Bartlett MD.

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Sharma, A.S., Flynn, J.R., Panageas, K.S. et al. Assessment of Frailty Can Guide Decision Making for Utilization of Sentinel Lymph Node Biopsy in Patients with Thick Melanoma. Ann Surg Oncol 28, 9031–9038 (2021). https://doi.org/10.1245/s10434-021-10212-w

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  • DOI: https://doi.org/10.1245/s10434-021-10212-w

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