Nodal Recurrence is a Primary Driver of Early Relapse for Patients with Sentinel Lymph Node-Positive Melanoma in the Modern Therapeutic Era
Background Management of patients with sentinel lymph node (SLN)-positive melanoma has changed dramatically over the last few years such that completion lymph node dissection (CLND) has become uncommon, and many patients receive adjuvant immunotherapy or targeted therapy. This study seeks to charact...
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Veröffentlicht in: | Annals of surgical oncology 2021-07, Vol.28 (7), p.3480-3489 |
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creator | Mitra, Devarati Ologun, Gabriel Keung, Emily Z. Goepfert, Ryan P. Amaria, Rodabe N. Ross, Merrick I. Gershenwald, Jeffrey E. Lucci, Anthony Fisher, Sarah B. Davies, Michael A. Lee, Jeffrey E. Bishop, Andrew J. Farooqi, Ahsan S. Wargo, Jennifer Guadagnolo, B. Ashleigh |
description | Background
Management of patients with sentinel lymph node (SLN)-positive melanoma has changed dramatically over the last few years such that completion lymph node dissection (CLND) has become uncommon, and many patients receive adjuvant immunotherapy or targeted therapy. This study seeks to characterize patterns and predictors of early recurrence in this setting.
Patients and Methods
All patients with primary cutaneous melanoma undergoing sentinel lymph node biopsy (SLNB) between 3/2016 and 12/2019 were identified. The subset with a positive SLN who did not undergo CLND were examined for further analysis of outcomes and predictors of recurrence.
Results
Overall, 215 patients with SLN-positive melanoma who did not have CLND were identified. Adjuvant systemic therapy was administered to 102 (47%), with 93% of this subset receiving immunotherapy (
n
= 95). Median follow-up from SLNB was 20 months (IQR 12–28.5 months), and 57 patients (27%) recurred during this time. The SLN basin was the most common site of recurrence (
n
= 38, 67% of recurrence), with isolated nodal recurrence being the most common first site of recurrent disease (
n
= 22, 39% of recurrence). On multivariable analysis, lymphovascular invasion (LVI) of the primary tumor, two or more involved nodes, and > 1 mm nodal deposit were independently associated with higher rates of nodal relapse.
Conclusions
Nodal recurrence is a primary driver of early disease relapse for patients with SLN-positive melanoma who do not undergo CLND in the era of effective adjuvant systemic therapy. LVI, ≥ 2 nodes, or > 1 mm nodal disease identifies patients at particularly high risk of nodal relapse. |
doi_str_mv | 10.1245/s10434-021-09804-3 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8636723</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2537863306</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-c0bd71f5773bff160d757e47106635c66a7263caee33f54c56c2855d0718a4cf3</originalsourceid><addsrcrecordid>eNp9kU1v1DAQhiMEoqXwBzigkTiH2vFXekFC7fIhbWEF5Wx5nXHjKmsHOyna39A_jUvaAhdOHs-888yM3qp6Sckb2nBxnCnhjNekoTU5aQmv2aPqkIqS4rKlj0tMZFufNFIcVM9yviKEKkbE0-qAsVZISdhhdfM5dmaAr2jnlDBYBJ_BwCb5nUl7OEv-GhNEByuThn3RDWbMCC4m2JjJY5gy_PRTD99K6AMOsN7vxh4KFutNzH4qADgvbSHuDPgAU1_-pZoCXPSYzIjz5C2sknlePXFmyPji7j2qvr9fXZx-rNdfPnw6fbeuLVd8qi3Zdoo6oRTbOkcl6ZRQyFW5VjJhpTSqkcwaRMac4FZI27RCdETR1nDr2FH1duGO83aHnS2bJzPocblZR-P1v5Xge30Zr3UrmVQNK4DXd4AUf8yYJ30V5xTKzroRTBUZI7KomkVlU8w5oXuYQIm-NVAvBupioP5toL5Fv_p7t4eWe8eKgC2CXErhEtOf2f_B_gLCzKgp</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2537863306</pqid></control><display><type>article</type><title>Nodal Recurrence is a Primary Driver of Early Relapse for Patients with Sentinel Lymph Node-Positive Melanoma in the Modern Therapeutic Era</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Mitra, Devarati ; Ologun, Gabriel ; Keung, Emily Z. ; Goepfert, Ryan P. ; Amaria, Rodabe N. ; Ross, Merrick I. ; Gershenwald, Jeffrey E. ; Lucci, Anthony ; Fisher, Sarah B. ; Davies, Michael A. ; Lee, Jeffrey E. ; Bishop, Andrew J. ; Farooqi, Ahsan S. ; Wargo, Jennifer ; Guadagnolo, B. Ashleigh</creator><creatorcontrib>Mitra, Devarati ; Ologun, Gabriel ; Keung, Emily Z. ; Goepfert, Ryan P. ; Amaria, Rodabe N. ; Ross, Merrick I. ; Gershenwald, Jeffrey E. ; Lucci, Anthony ; Fisher, Sarah B. ; Davies, Michael A. ; Lee, Jeffrey E. ; Bishop, Andrew J. ; Farooqi, Ahsan S. ; Wargo, Jennifer ; Guadagnolo, B. Ashleigh</creatorcontrib><description>Background
Management of patients with sentinel lymph node (SLN)-positive melanoma has changed dramatically over the last few years such that completion lymph node dissection (CLND) has become uncommon, and many patients receive adjuvant immunotherapy or targeted therapy. This study seeks to characterize patterns and predictors of early recurrence in this setting.
Patients and Methods
All patients with primary cutaneous melanoma undergoing sentinel lymph node biopsy (SLNB) between 3/2016 and 12/2019 were identified. The subset with a positive SLN who did not undergo CLND were examined for further analysis of outcomes and predictors of recurrence.
Results
Overall, 215 patients with SLN-positive melanoma who did not have CLND were identified. Adjuvant systemic therapy was administered to 102 (47%), with 93% of this subset receiving immunotherapy (
n
= 95). Median follow-up from SLNB was 20 months (IQR 12–28.5 months), and 57 patients (27%) recurred during this time. The SLN basin was the most common site of recurrence (
n
= 38, 67% of recurrence), with isolated nodal recurrence being the most common first site of recurrent disease (
n
= 22, 39% of recurrence). On multivariable analysis, lymphovascular invasion (LVI) of the primary tumor, two or more involved nodes, and > 1 mm nodal deposit were independently associated with higher rates of nodal relapse.
Conclusions
Nodal recurrence is a primary driver of early disease relapse for patients with SLN-positive melanoma who do not undergo CLND in the era of effective adjuvant systemic therapy. LVI, ≥ 2 nodes, or > 1 mm nodal disease identifies patients at particularly high risk of nodal relapse.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-021-09804-3</identifier><identifier>PMID: 33856603</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Biopsy ; Humans ; Immunotherapy ; Lymph Node Excision ; Lymph nodes ; Lymphatic system ; Medicine ; Medicine & Public Health ; Melanoma ; Melanoma - surgery ; Neoplasm Recurrence, Local - surgery ; Oncology ; Retrospective Studies ; Sentinel Lymph Node - surgery ; Sentinel Lymph Node Biopsy ; Skin Neoplasms - surgery ; Surgery ; Surgical Oncology</subject><ispartof>Annals of surgical oncology, 2021-07, Vol.28 (7), p.3480-3489</ispartof><rights>Society of Surgical Oncology 2021</rights><rights>Society of Surgical Oncology 2021.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-c0bd71f5773bff160d757e47106635c66a7263caee33f54c56c2855d0718a4cf3</citedby><cites>FETCH-LOGICAL-c474t-c0bd71f5773bff160d757e47106635c66a7263caee33f54c56c2855d0718a4cf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-021-09804-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-021-09804-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33856603$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mitra, Devarati</creatorcontrib><creatorcontrib>Ologun, Gabriel</creatorcontrib><creatorcontrib>Keung, Emily Z.</creatorcontrib><creatorcontrib>Goepfert, Ryan P.</creatorcontrib><creatorcontrib>Amaria, Rodabe N.</creatorcontrib><creatorcontrib>Ross, Merrick I.</creatorcontrib><creatorcontrib>Gershenwald, Jeffrey E.</creatorcontrib><creatorcontrib>Lucci, Anthony</creatorcontrib><creatorcontrib>Fisher, Sarah B.</creatorcontrib><creatorcontrib>Davies, Michael A.</creatorcontrib><creatorcontrib>Lee, Jeffrey E.</creatorcontrib><creatorcontrib>Bishop, Andrew J.</creatorcontrib><creatorcontrib>Farooqi, Ahsan S.</creatorcontrib><creatorcontrib>Wargo, Jennifer</creatorcontrib><creatorcontrib>Guadagnolo, B. Ashleigh</creatorcontrib><title>Nodal Recurrence is a Primary Driver of Early Relapse for Patients with Sentinel Lymph Node-Positive Melanoma in the Modern Therapeutic Era</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
Management of patients with sentinel lymph node (SLN)-positive melanoma has changed dramatically over the last few years such that completion lymph node dissection (CLND) has become uncommon, and many patients receive adjuvant immunotherapy or targeted therapy. This study seeks to characterize patterns and predictors of early recurrence in this setting.
Patients and Methods
All patients with primary cutaneous melanoma undergoing sentinel lymph node biopsy (SLNB) between 3/2016 and 12/2019 were identified. The subset with a positive SLN who did not undergo CLND were examined for further analysis of outcomes and predictors of recurrence.
Results
Overall, 215 patients with SLN-positive melanoma who did not have CLND were identified. Adjuvant systemic therapy was administered to 102 (47%), with 93% of this subset receiving immunotherapy (
n
= 95). Median follow-up from SLNB was 20 months (IQR 12–28.5 months), and 57 patients (27%) recurred during this time. The SLN basin was the most common site of recurrence (
n
= 38, 67% of recurrence), with isolated nodal recurrence being the most common first site of recurrent disease (
n
= 22, 39% of recurrence). On multivariable analysis, lymphovascular invasion (LVI) of the primary tumor, two or more involved nodes, and > 1 mm nodal deposit were independently associated with higher rates of nodal relapse.
Conclusions
Nodal recurrence is a primary driver of early disease relapse for patients with SLN-positive melanoma who do not undergo CLND in the era of effective adjuvant systemic therapy. LVI, ≥ 2 nodes, or > 1 mm nodal disease identifies patients at particularly high risk of nodal relapse.</description><subject>Biopsy</subject><subject>Humans</subject><subject>Immunotherapy</subject><subject>Lymph Node Excision</subject><subject>Lymph nodes</subject><subject>Lymphatic system</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Melanoma</subject><subject>Melanoma - surgery</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Oncology</subject><subject>Retrospective Studies</subject><subject>Sentinel Lymph Node - surgery</subject><subject>Sentinel Lymph Node Biopsy</subject><subject>Skin Neoplasms - surgery</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU1v1DAQhiMEoqXwBzigkTiH2vFXekFC7fIhbWEF5Wx5nXHjKmsHOyna39A_jUvaAhdOHs-888yM3qp6Sckb2nBxnCnhjNekoTU5aQmv2aPqkIqS4rKlj0tMZFufNFIcVM9yviKEKkbE0-qAsVZISdhhdfM5dmaAr2jnlDBYBJ_BwCb5nUl7OEv-GhNEByuThn3RDWbMCC4m2JjJY5gy_PRTD99K6AMOsN7vxh4KFutNzH4qADgvbSHuDPgAU1_-pZoCXPSYzIjz5C2sknlePXFmyPji7j2qvr9fXZx-rNdfPnw6fbeuLVd8qi3Zdoo6oRTbOkcl6ZRQyFW5VjJhpTSqkcwaRMac4FZI27RCdETR1nDr2FH1duGO83aHnS2bJzPocblZR-P1v5Xge30Zr3UrmVQNK4DXd4AUf8yYJ30V5xTKzroRTBUZI7KomkVlU8w5oXuYQIm-NVAvBupioP5toL5Fv_p7t4eWe8eKgC2CXErhEtOf2f_B_gLCzKgp</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Mitra, Devarati</creator><creator>Ologun, Gabriel</creator><creator>Keung, Emily Z.</creator><creator>Goepfert, Ryan P.</creator><creator>Amaria, Rodabe N.</creator><creator>Ross, Merrick I.</creator><creator>Gershenwald, Jeffrey E.</creator><creator>Lucci, Anthony</creator><creator>Fisher, Sarah B.</creator><creator>Davies, Michael A.</creator><creator>Lee, Jeffrey E.</creator><creator>Bishop, Andrew J.</creator><creator>Farooqi, Ahsan S.</creator><creator>Wargo, Jennifer</creator><creator>Guadagnolo, B. Ashleigh</creator><general>Springer International Publishing</general><general>Springer Nature B.V</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>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>5PM</scope></search><sort><creationdate>20210701</creationdate><title>Nodal Recurrence is a Primary Driver of Early Relapse for Patients with Sentinel Lymph Node-Positive Melanoma in the Modern Therapeutic Era</title><author>Mitra, Devarati ; Ologun, Gabriel ; Keung, Emily Z. ; Goepfert, Ryan P. ; Amaria, Rodabe N. ; Ross, Merrick I. ; Gershenwald, Jeffrey E. ; Lucci, Anthony ; Fisher, Sarah B. ; Davies, Michael A. ; Lee, Jeffrey E. ; Bishop, Andrew J. ; Farooqi, Ahsan S. ; Wargo, Jennifer ; Guadagnolo, B. Ashleigh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-c0bd71f5773bff160d757e47106635c66a7263caee33f54c56c2855d0718a4cf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Biopsy</topic><topic>Humans</topic><topic>Immunotherapy</topic><topic>Lymph Node Excision</topic><topic>Lymph nodes</topic><topic>Lymphatic system</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Melanoma</topic><topic>Melanoma - surgery</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Oncology</topic><topic>Retrospective Studies</topic><topic>Sentinel Lymph Node - surgery</topic><topic>Sentinel Lymph Node Biopsy</topic><topic>Skin Neoplasms - surgery</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mitra, Devarati</creatorcontrib><creatorcontrib>Ologun, Gabriel</creatorcontrib><creatorcontrib>Keung, Emily Z.</creatorcontrib><creatorcontrib>Goepfert, Ryan P.</creatorcontrib><creatorcontrib>Amaria, Rodabe N.</creatorcontrib><creatorcontrib>Ross, Merrick I.</creatorcontrib><creatorcontrib>Gershenwald, Jeffrey E.</creatorcontrib><creatorcontrib>Lucci, Anthony</creatorcontrib><creatorcontrib>Fisher, Sarah B.</creatorcontrib><creatorcontrib>Davies, Michael A.</creatorcontrib><creatorcontrib>Lee, Jeffrey E.</creatorcontrib><creatorcontrib>Bishop, Andrew J.</creatorcontrib><creatorcontrib>Farooqi, Ahsan S.</creatorcontrib><creatorcontrib>Wargo, Jennifer</creatorcontrib><creatorcontrib>Guadagnolo, B. Ashleigh</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mitra, Devarati</au><au>Ologun, Gabriel</au><au>Keung, Emily Z.</au><au>Goepfert, Ryan P.</au><au>Amaria, Rodabe N.</au><au>Ross, Merrick I.</au><au>Gershenwald, Jeffrey E.</au><au>Lucci, Anthony</au><au>Fisher, Sarah B.</au><au>Davies, Michael A.</au><au>Lee, Jeffrey E.</au><au>Bishop, Andrew J.</au><au>Farooqi, Ahsan S.</au><au>Wargo, Jennifer</au><au>Guadagnolo, B. Ashleigh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nodal Recurrence is a Primary Driver of Early Relapse for Patients with Sentinel Lymph Node-Positive Melanoma in the Modern Therapeutic Era</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2021-07-01</date><risdate>2021</risdate><volume>28</volume><issue>7</issue><spage>3480</spage><epage>3489</epage><pages>3480-3489</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
Management of patients with sentinel lymph node (SLN)-positive melanoma has changed dramatically over the last few years such that completion lymph node dissection (CLND) has become uncommon, and many patients receive adjuvant immunotherapy or targeted therapy. This study seeks to characterize patterns and predictors of early recurrence in this setting.
Patients and Methods
All patients with primary cutaneous melanoma undergoing sentinel lymph node biopsy (SLNB) between 3/2016 and 12/2019 were identified. The subset with a positive SLN who did not undergo CLND were examined for further analysis of outcomes and predictors of recurrence.
Results
Overall, 215 patients with SLN-positive melanoma who did not have CLND were identified. Adjuvant systemic therapy was administered to 102 (47%), with 93% of this subset receiving immunotherapy (
n
= 95). Median follow-up from SLNB was 20 months (IQR 12–28.5 months), and 57 patients (27%) recurred during this time. The SLN basin was the most common site of recurrence (
n
= 38, 67% of recurrence), with isolated nodal recurrence being the most common first site of recurrent disease (
n
= 22, 39% of recurrence). On multivariable analysis, lymphovascular invasion (LVI) of the primary tumor, two or more involved nodes, and > 1 mm nodal deposit were independently associated with higher rates of nodal relapse.
Conclusions
Nodal recurrence is a primary driver of early disease relapse for patients with SLN-positive melanoma who do not undergo CLND in the era of effective adjuvant systemic therapy. LVI, ≥ 2 nodes, or > 1 mm nodal disease identifies patients at particularly high risk of nodal relapse.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>33856603</pmid><doi>10.1245/s10434-021-09804-3</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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source | MEDLINE; SpringerNature Journals |
subjects | Biopsy Humans Immunotherapy Lymph Node Excision Lymph nodes Lymphatic system Medicine Medicine & Public Health Melanoma Melanoma - surgery Neoplasm Recurrence, Local - surgery Oncology Retrospective Studies Sentinel Lymph Node - surgery Sentinel Lymph Node Biopsy Skin Neoplasms - surgery Surgery Surgical Oncology |
title | Nodal Recurrence is a Primary Driver of Early Relapse for Patients with Sentinel Lymph Node-Positive Melanoma in the Modern Therapeutic Era |
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