Nodal Basin Recurrence After Sentinel Lymph Node Biopsy for Melanoma

TY - JOUR

T1 - Nodal Basin Recurrence After Sentinel Lymph Node Biopsy for Melanoma

T2 - A Retrospective Multicenter Study in 2653 Patients

AU - Kretschmer, Lutz

AU - Bertsch, Hans Peter

AU - Zapf, Antonia

AU - Mitteldorf, Christina

AU - Satzger, Imke

AU - Thoms, Kai-Martin

AU - Völker, Bernward

AU - Schön, Michael Peter

AU - Gutzmer, Ralf

AU - Starz, Hans

PY - 2015/9

Y1 - 2015/9

N2 - UNLABELLED: The objective of this study was to analyze different types of nodal basin recurrence after sentinel lymph node biopsy (SLNB) for melanoma.PATIENTS AND METHODS: Kaplan-Meier estimates and the Cox proportional hazards model were used to study 2653 patients from 3 German melanoma centers retrospectively.The estimated 5-year negative predictive value of SLNB was 96.4%. The estimated false-negative (FN) rates after 1, 2, 3, 5, and 10 years were 2.5%, 4.6%, 6.4%, 8.7%, and 12.6%, respectively. Independent factors associated with false negativity were older age, fewer SLNs excised, and head or neck location of the primary tumor. Compared with SLN-positive patients, the FNs had a significantly lower survival. In SLN-positive patients undergoing completion lymphadenectomy (CLND), the 5-year nodal basin recurrence rate was 18.3%. The recurrence rates for axilla, groin, and neck were 17.2%, 15.5%, and 44.1%, respectively. Significant factors predicting local relapse after CLND were older age, head, or neck location of the primary tumor, ulceration, deeper penetration of the metastasis into the SLN, tumor-positive CLND, and >2 lymph node metastases. All kinds of nodal relapse were associated with a higher prevalence of in-transit metastases.The FN rate after SLNB steadily increases over the observation period and should, therefore, be estimated by the Kaplan-Meier method. False-negativity is associated with fewer SLNs excised. The beneficial effect of CLND on nodal basin disease control varies considerably across different risk groups. This should be kept in mind about SLN-positive patients when individual decisions on prophylactic CLND are taken.

AB - UNLABELLED: The objective of this study was to analyze different types of nodal basin recurrence after sentinel lymph node biopsy (SLNB) for melanoma.PATIENTS AND METHODS: Kaplan-Meier estimates and the Cox proportional hazards model were used to study 2653 patients from 3 German melanoma centers retrospectively.The estimated 5-year negative predictive value of SLNB was 96.4%. The estimated false-negative (FN) rates after 1, 2, 3, 5, and 10 years were 2.5%, 4.6%, 6.4%, 8.7%, and 12.6%, respectively. Independent factors associated with false negativity were older age, fewer SLNs excised, and head or neck location of the primary tumor. Compared with SLN-positive patients, the FNs had a significantly lower survival. In SLN-positive patients undergoing completion lymphadenectomy (CLND), the 5-year nodal basin recurrence rate was 18.3%. The recurrence rates for axilla, groin, and neck were 17.2%, 15.5%, and 44.1%, respectively. Significant factors predicting local relapse after CLND were older age, head, or neck location of the primary tumor, ulceration, deeper penetration of the metastasis into the SLN, tumor-positive CLND, and >2 lymph node metastases. All kinds of nodal relapse were associated with a higher prevalence of in-transit metastases.The FN rate after SLNB steadily increases over the observation period and should, therefore, be estimated by the Kaplan-Meier method. False-negativity is associated with fewer SLNs excised. The beneficial effect of CLND on nodal basin disease control varies considerably across different risk groups. This should be kept in mind about SLN-positive patients when individual decisions on prophylactic CLND are taken.

KW - Adult

KW - Aged

KW - Female

KW - Germany

KW - Humans

KW - Kaplan-Meier Estimate

KW - Lymph Node Excision

KW - Lymph Nodes

KW - Lymphatic Metastasis

KW - Male

KW - Melanoma

KW - Middle Aged

KW - Neoplasm Recurrence, Local

KW - Neoplasm Staging

KW - Prognosis

KW - Retrospective Studies

KW - Risk Assessment

KW - Sentinel Lymph Node Biopsy

KW - Journal Article

KW - Multicenter Study

KW - Observational Study

U2 - 10.1097/MD.0000000000001433

DO - 10.1097/MD.0000000000001433

M3 - SCORING: Journal article

C2 - 26356697

VL - 94

SP - e1433

JO - MEDICINE

JF - MEDICINE

SN - 0025-7974

IS - 36

ER -