title: Is there a therapeutic benefit of complete lymph node dissection in melanoma patients with low tumor burden in the sentinel node?
abstract: In the case of a positive sentinel lymph node (SLN), melanoma patients are recommended to proceed to complete lymph node dissection (CLND). However, CLND for SLN-positive patients - especially with minimal tumor burden in SLN - is becoming more controversial. We analyzed the clinical course of 305 SLN-positive patients with a mean follow-up of 51.1 months by Kaplan-Meier analyses. Overall, 58/305 (17%) patients did not undergo CLND. These were compared with a matched selection of 58 comparable patients who underwent CLND. Moreover, 106/305 patients with minimal tumor burden in SLN (<0.1 mm diameter of the largest tumor deposit) were analyzed separately. Of these 106 patients, 34 did not undergo CLND, whereas 72/106 patients were treated by CLND. In the matched groups, the CLND group and the non-CLND group did not differ significantly with respect to clinical characteristics, characteristics of the primary melanoma, and histopathological parameters of SLN. There were no differences in recurrence-free survival (P=0.765) and overall survival (P=0.844). The total number of regional lymph node metastases and time to regional lymph node metastases were not significantly higher for non-CLND patients. The subgroup of patients with minimal tumor burden in SLN also did not benefit significantly from CLND. In our analyses from a single German center, we could not find any evidence for a therapeutic survival benefit for CLND after positive SLN. However, future prospective randomized trials should confirm these data.
authors.affiliation: aDepartment of Dermatology and Allergy, Hannover Medical School, Hannover bInstitute for Biostatistics, Universitätsmedizin Göttingen, Göttingen, Germany.
authors.forename: Imke
authors.initials: I
authors.lastname: Satzger
authors.forename: Andre
authors.initials: A
authors.lastname: Meier
authors.forename: Antonia
authors.initials: A
authors.lastname: Zapf
authors.forename: Margarete
authors.initials: M
authors.lastname: Niebuhr
authors.forename: Alexander
authors.initials: A
authors.lastname: Kapp
authors.forename: Ralf
authors.initials: R
authors.lastname: Gutzmer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult