Outcome Following Sentinel Node Biopsy Plus Wide Local Excision Versus Wide Local Excision Only for Primary Cutaneous Melanoma: Analysis of 5840 Patients Treated at a Single Institution
OBJECTIVE:Worldwide, sentinel node biopsy (SNB) is now a standard staging procedure for most patients with melanomas 1 mm or more in thickness, but its therapeutic benefit is not clear, pending randomized trial results. This study sought to assess the therapeutic benefit of SNB in a large, nonrandom...
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| Veröffentlicht in: | Annals of surgery 2014-07, Vol.260 (1), p.149-157 |
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| creator | van der Ploeg, Augustinus P T Haydu, Lauren E Spillane, Andrew J Quinn, Michael J Saw, Robyn PM Shannon, Kerwin F Stretch, Jonathan R Uren, Roger F Scolyer, Richard A Thompson, John F |
| description | OBJECTIVE:Worldwide, sentinel node biopsy (SNB) is now a standard staging procedure for most patients with melanomas 1 mm or more in thickness, but its therapeutic benefit is not clear, pending randomized trial results. This study sought to assess the therapeutic benefit of SNB in a large, nonrandomized patient cohort.
METHODS:Patients with primary melanomas 1.00 mm or more thick or with adverse prognostic features treated with wide local excision (WLE) at a single institution between 1992 and 2008 were identified. The outcomes for those who underwent WLE plus SNB (n = 2909) were compared with the outcomes for patients in an observation (OBS) group who had WLE only (n = 2931). Median follow-up was 42 months.
RESULTS:Melanoma-specific survival (MSS) was not significantly different for patients in the SNB and OBS groups. However, a stratified univariate analysis of MSS for different thickness subgroups indicated a significantly better MSS for SNB patients with T2 and T3 melanomas (>1.0 to 4.0 mm thick) (P = 0.011), but this was not independently significant in multivariate analysis. Compared with OBS patients, SNB patients demonstrated improved disease-free survival (DFS) (P < 0.001) and regional recurrence-free survival (P < 0.001). There was also an improvement in distant metastasis-free survival (DMFS) for SNB patients with T2 and T3 melanomas (P = 0.041).
CONCLUSIONS:In this study, the outcome for the overall cohort after WLE alone did not differ significantly from the outcome after additional SNB. However, the outcome for the subgroup of patients with melanomas more than 1.0 to 4.0 mm in thickness was improved if they had a SNB, with significantly improved disease-free and DMFS. |
| doi_str_mv | 10.1097/SLA.0000000000000500 |
| format | Article |
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METHODS:Patients with primary melanomas 1.00 mm or more thick or with adverse prognostic features treated with wide local excision (WLE) at a single institution between 1992 and 2008 were identified. The outcomes for those who underwent WLE plus SNB (n = 2909) were compared with the outcomes for patients in an observation (OBS) group who had WLE only (n = 2931). Median follow-up was 42 months.
RESULTS:Melanoma-specific survival (MSS) was not significantly different for patients in the SNB and OBS groups. However, a stratified univariate analysis of MSS for different thickness subgroups indicated a significantly better MSS for SNB patients with T2 and T3 melanomas (>1.0 to 4.0 mm thick) (P = 0.011), but this was not independently significant in multivariate analysis. Compared with OBS patients, SNB patients demonstrated improved disease-free survival (DFS) (P < 0.001) and regional recurrence-free survival (P < 0.001). There was also an improvement in distant metastasis-free survival (DMFS) for SNB patients with T2 and T3 melanomas (P = 0.041).
CONCLUSIONS:In this study, the outcome for the overall cohort after WLE alone did not differ significantly from the outcome after additional SNB. However, the outcome for the subgroup of patients with melanomas more than 1.0 to 4.0 mm in thickness was improved if they had a SNB, with significantly improved disease-free and DMFS.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000000500</identifier><identifier>PMID: 24633018</identifier><language>eng</language><publisher>United States: by Lippincott Williams & Wilkins</publisher><subject>Dermatologic Surgical Procedures - methods ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Melanoma - diagnosis ; Melanoma - secondary ; Melanoma - surgery ; Melanoma, Cutaneous Malignant ; Middle Aged ; Neoplasm Recurrence, Local ; Prognosis ; Prospective Studies ; Sentinel Lymph Node Biopsy - methods ; Skin Neoplasms - diagnosis ; Skin Neoplasms - secondary ; Skin Neoplasms - surgery</subject><ispartof>Annals of surgery, 2014-07, Vol.260 (1), p.149-157</ispartof><rights>2014 by Lippincott Williams & Wilkins.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3050-49840b263e4dbe639368a1f1d2b924c517ade325849bb7d0478251c578ac52743</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24633018$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van der Ploeg, Augustinus P T</creatorcontrib><creatorcontrib>Haydu, Lauren E</creatorcontrib><creatorcontrib>Spillane, Andrew J</creatorcontrib><creatorcontrib>Quinn, Michael J</creatorcontrib><creatorcontrib>Saw, Robyn PM</creatorcontrib><creatorcontrib>Shannon, Kerwin F</creatorcontrib><creatorcontrib>Stretch, Jonathan R</creatorcontrib><creatorcontrib>Uren, Roger F</creatorcontrib><creatorcontrib>Scolyer, Richard A</creatorcontrib><creatorcontrib>Thompson, John F</creatorcontrib><title>Outcome Following Sentinel Node Biopsy Plus Wide Local Excision Versus Wide Local Excision Only for Primary Cutaneous Melanoma: Analysis of 5840 Patients Treated at a Single Institution</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>OBJECTIVE:Worldwide, sentinel node biopsy (SNB) is now a standard staging procedure for most patients with melanomas 1 mm or more in thickness, but its therapeutic benefit is not clear, pending randomized trial results. This study sought to assess the therapeutic benefit of SNB in a large, nonrandomized patient cohort.
METHODS:Patients with primary melanomas 1.00 mm or more thick or with adverse prognostic features treated with wide local excision (WLE) at a single institution between 1992 and 2008 were identified. The outcomes for those who underwent WLE plus SNB (n = 2909) were compared with the outcomes for patients in an observation (OBS) group who had WLE only (n = 2931). Median follow-up was 42 months.
RESULTS:Melanoma-specific survival (MSS) was not significantly different for patients in the SNB and OBS groups. However, a stratified univariate analysis of MSS for different thickness subgroups indicated a significantly better MSS for SNB patients with T2 and T3 melanomas (>1.0 to 4.0 mm thick) (P = 0.011), but this was not independently significant in multivariate analysis. Compared with OBS patients, SNB patients demonstrated improved disease-free survival (DFS) (P < 0.001) and regional recurrence-free survival (P < 0.001). There was also an improvement in distant metastasis-free survival (DMFS) for SNB patients with T2 and T3 melanomas (P = 0.041).
CONCLUSIONS:In this study, the outcome for the overall cohort after WLE alone did not differ significantly from the outcome after additional SNB. However, the outcome for the subgroup of patients with melanomas more than 1.0 to 4.0 mm in thickness was improved if they had a SNB, with significantly improved disease-free and DMFS.</description><subject>Dermatologic Surgical Procedures - methods</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Lymph Node Excision</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Melanoma - diagnosis</subject><subject>Melanoma - secondary</subject><subject>Melanoma - surgery</subject><subject>Melanoma, Cutaneous Malignant</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Sentinel Lymph Node Biopsy - methods</subject><subject>Skin Neoplasms - diagnosis</subject><subject>Skin Neoplasms - secondary</subject><subject>Skin Neoplasms - surgery</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UU2P0zAQtRCILQv_AKE5cuniryQOt1LtwkqFVuoCx8hxJqzBiYvtqPSn8e8wyoIQEsxlpJk3b-bNI-QpoxeM1tWL_WZ1Qf-MgtJ7ZMEKrpaMSXqfLHJRLGUt-Bl5FONnSplUtHpIzrgshaBMLcj37ZSMHxCuvHP-aMdPsMcx2REdvPMdwivrD_EEOzdF-GhzYeONdnD5zdho_QgfMMR_tLajO0HvA-yCHXQ4wXpKekSf4W_R6dEP-iWsRu1O0UbwPRRKUtjpZPMFEW4C6oQd6AQa9vkyh3A9xmTTlDL9Y_Kg1y7ik7t8Tt5fXd6s3yw329fX69VmaUR-SZafSVteCpRdi6WoRak061nH25pLU7BKdyh4Xl23bdVRWSleMFNUSpuCV1Kck-cz7yH4rxPG1Aw2GnRultKwQkhal4rRDJUz1AQfY8C-OczKG0abn6Y12bTmb9Py2LO7DVM7YPd76JdLGaBmwNG7lP_9xU1HDM0tapdu_8_9AzPvo98</recordid><startdate>201407</startdate><enddate>201407</enddate><creator>van der Ploeg, Augustinus P T</creator><creator>Haydu, Lauren E</creator><creator>Spillane, Andrew J</creator><creator>Quinn, Michael J</creator><creator>Saw, Robyn PM</creator><creator>Shannon, Kerwin F</creator><creator>Stretch, Jonathan R</creator><creator>Uren, Roger F</creator><creator>Scolyer, Richard A</creator><creator>Thompson, John F</creator><general>by Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201407</creationdate><title>Outcome Following Sentinel Node Biopsy Plus Wide Local Excision Versus Wide Local Excision Only for Primary Cutaneous Melanoma: Analysis of 5840 Patients Treated at a Single Institution</title><author>van der Ploeg, Augustinus P T ; Haydu, Lauren E ; Spillane, Andrew J ; Quinn, Michael J ; Saw, Robyn PM ; Shannon, Kerwin F ; Stretch, Jonathan R ; Uren, Roger F ; Scolyer, Richard A ; Thompson, John F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3050-49840b263e4dbe639368a1f1d2b924c517ade325849bb7d0478251c578ac52743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Dermatologic Surgical Procedures - methods</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Lymph Node Excision</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Melanoma - diagnosis</topic><topic>Melanoma - secondary</topic><topic>Melanoma - surgery</topic><topic>Melanoma, Cutaneous Malignant</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Sentinel Lymph Node Biopsy - methods</topic><topic>Skin Neoplasms - diagnosis</topic><topic>Skin Neoplasms - secondary</topic><topic>Skin Neoplasms - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van der Ploeg, Augustinus P T</creatorcontrib><creatorcontrib>Haydu, Lauren E</creatorcontrib><creatorcontrib>Spillane, Andrew J</creatorcontrib><creatorcontrib>Quinn, Michael J</creatorcontrib><creatorcontrib>Saw, Robyn PM</creatorcontrib><creatorcontrib>Shannon, Kerwin F</creatorcontrib><creatorcontrib>Stretch, Jonathan R</creatorcontrib><creatorcontrib>Uren, Roger F</creatorcontrib><creatorcontrib>Scolyer, Richard A</creatorcontrib><creatorcontrib>Thompson, John F</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van der Ploeg, Augustinus P T</au><au>Haydu, Lauren E</au><au>Spillane, Andrew J</au><au>Quinn, Michael J</au><au>Saw, Robyn PM</au><au>Shannon, Kerwin F</au><au>Stretch, Jonathan R</au><au>Uren, Roger F</au><au>Scolyer, Richard A</au><au>Thompson, John F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcome Following Sentinel Node Biopsy Plus Wide Local Excision Versus Wide Local Excision Only for Primary Cutaneous Melanoma: Analysis of 5840 Patients Treated at a Single Institution</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2014-07</date><risdate>2014</risdate><volume>260</volume><issue>1</issue><spage>149</spage><epage>157</epage><pages>149-157</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>OBJECTIVE:Worldwide, sentinel node biopsy (SNB) is now a standard staging procedure for most patients with melanomas 1 mm or more in thickness, but its therapeutic benefit is not clear, pending randomized trial results. This study sought to assess the therapeutic benefit of SNB in a large, nonrandomized patient cohort.
METHODS:Patients with primary melanomas 1.00 mm or more thick or with adverse prognostic features treated with wide local excision (WLE) at a single institution between 1992 and 2008 were identified. The outcomes for those who underwent WLE plus SNB (n = 2909) were compared with the outcomes for patients in an observation (OBS) group who had WLE only (n = 2931). Median follow-up was 42 months.
RESULTS:Melanoma-specific survival (MSS) was not significantly different for patients in the SNB and OBS groups. However, a stratified univariate analysis of MSS for different thickness subgroups indicated a significantly better MSS for SNB patients with T2 and T3 melanomas (>1.0 to 4.0 mm thick) (P = 0.011), but this was not independently significant in multivariate analysis. Compared with OBS patients, SNB patients demonstrated improved disease-free survival (DFS) (P < 0.001) and regional recurrence-free survival (P < 0.001). There was also an improvement in distant metastasis-free survival (DMFS) for SNB patients with T2 and T3 melanomas (P = 0.041).
CONCLUSIONS:In this study, the outcome for the overall cohort after WLE alone did not differ significantly from the outcome after additional SNB. However, the outcome for the subgroup of patients with melanomas more than 1.0 to 4.0 mm in thickness was improved if they had a SNB, with significantly improved disease-free and DMFS.</abstract><cop>United States</cop><pub>by Lippincott Williams & Wilkins</pub><pmid>24633018</pmid><doi>10.1097/SLA.0000000000000500</doi><tpages>9</tpages></addata></record> |
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| ispartof | Annals of surgery, 2014-07, Vol.260 (1), p.149-157 |
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| subjects | Dermatologic Surgical Procedures - methods Disease-Free Survival Female Follow-Up Studies Humans Lymph Node Excision Lymphatic Metastasis Male Melanoma - diagnosis Melanoma - secondary Melanoma - surgery Melanoma, Cutaneous Malignant Middle Aged Neoplasm Recurrence, Local Prognosis Prospective Studies Sentinel Lymph Node Biopsy - methods Skin Neoplasms - diagnosis Skin Neoplasms - secondary Skin Neoplasms - surgery |
| title | Outcome Following Sentinel Node Biopsy Plus Wide Local Excision Versus Wide Local Excision Only for Primary Cutaneous Melanoma: Analysis of 5840 Patients Treated at a Single Institution |
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