Regional Node Basin Recurrence in Melanoma Patients: More Common After Node Dissection for Macroscopic Rather than Clinically Occult Nodal Disease

• Published in: Annals of surgical oncology Vol. 27; no. 6; pp. 1970 - 1977
• Main Authors: Uppal, Abhineet, Stern, Stacey, Thompson, John F., Foshag, Leland, Mizzollo, Nicola, Nieweg, Omgo E., Hoekstra, Harald J., Roses, Daniel F., Sondak, Vernon K., Kashani-Sabet, Mohammed, Coventry, Brendon J., Cochran, Alistair J., Fujita, Manabu, Sim-Shin, Myung, Elashoff, David, Elashoff, Robert M., Faries, Mark B.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2020; Springer Nature B.V
• Subjects: Clinical trials; Databases, Factual; Demography; Dissection; Female; Humans; Lymph Node Excision - mortality; Lymph nodes; Lymphatic system; Male; Medicine; Medicine & Public Health; Melanoma; Melanoma - mortality; Melanoma - pathology; Melanoma - therapy; Metastases; Metastasis; Middle Aged; Multivariate Analysis; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Neoplasm Staging; Oncology; Patients; Quality of Life; Radiation therapy; Radiotherapy, Adjuvant; Retrospective Studies; Sentinel Lymph Node Biopsy; Surgery; Surgical Oncology; Survival Rate
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-019-08086-0

Background Recommended treatment for patients with sentinel lymph node (SLN)-positive melanoma has recently changed. Randomized trials demonstrated equivalent survival with close observation versus completion lymph node dissection (CLND), but increased regional node recurrence. We evaluated factors related to in-basin nodal recurrence after lymphadenectomy (LND) for SLN-positive or macroscopic nodal metastases. Methods An institutional database and the first Multicenter Selective Lymphadenectomy Trial (MSLT-I) were analyzed independently. Exclusions were multiple primaries, multi-basin involvement, or in-transit metastases. Patient demographics, primary tumor thickness and ulceration, lymph nodes retrieved, and use of adjuvant radiotherapy were analyzed. Multivariate analyses were performed to determine factors predicting in-basin nodal recurrence (significance p  ≤ 0.05). Results The retrospective cohort (577 patients) showed an in-basin failure rate of 6.6% after CLND for a positive SLN and 13.1% after LND for palpable disease ( p  = 0.001). This recurrence risk persisted after adjustment for patient, tumor, and LND factors [hazard ratio (HR) 2.32; p  = 0.004]. In the MSLT-I cohort (326 patients), the failure rate after CLND following SLNB was 6.2%, but 10.1% after LND for palpable recurrence in observation patients. After adjustment for other factors, macroscopic disease was associated with an increased risk of recurrence after LND (HR 2.24; p  = 0.05). Conclusion After LND for melanoma, in-basin recurrence is infrequent, but a clinically significant fraction will fail. Failure is less likely if dissection is performed for clinically occult disease. Further research is warranted to evaluate the long-term regional control and quality of life associated with nodal basin observation, which has now become standard practice.