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Melanoma Patients And Selective Sentinel Lymph Node Dissection
A DGReview of :"Clinical Outcome of Stage I/II Melanoma Patients After Selective Sentinel Lymph Node Dissection: Long-Term Follow-Up Results"
Journal of Clinical Oncology (JCO)
03/20/2003
By Anne MacLennan
Triple-technique sentinel lymph node (SLN) dissection is reliable and accurate in melanoma patients, say researchers.
The success rate is 99.5%, report investigators from VU University Medical Center, Amsterdam, the Netherlands.
Although survival data appear promising in this study, the therapeutic effect of the procedure is still questionable, note Dr R J Vuylsteke and colleagues. However, as illustrated in this study, not all SLN-positive patients have a poor prognosis.
There has been no final proof the SLN procedure influences disease outcome in melanoma patients although SLN status is part of the new American Joint Committee on Cancer staging system. These investigators examined accuracy of the procedure and clinical outcome in 209 patients after at least 60 months of follow up.
The patients, who were seen between 1993 and 1996 and had stage I/II cutaneous melanoma, underwent selective SLN dissection by the triple technique. If the SLN contained metastatic disease, a completion lymphadenectomy was done.
For survival analyses, the investigators used the Kaplan-Meier approach. Factors linked with survival were analysed via the Cox proportional hazards regression model. They found success rate was 99.5% after a median follow-up of 72 months. Forty (19%) of the patients had a positive SLN, whereas the false-negative rate was 9%.
For the entire group, 5-year overall survival was 87%. It was 92 and 67%, respectively, for SLN-negative and SLN-positive patients.
All patients with a positive SLN and a Breslow thickness of 1.00 mm or less survived, and those with a Breslow thickness less than 2.00 mm tended to have a better prognosis as compared with SLN-negative patients with a Breslow thickness greater than 2.00 mm.
Independent prognostic factors for overall survival were found to be SLN status, Breslow thickness and lymphatic invasion, the study found.
J Clin Oncol 2003 Mar 15;21:6:1057-65.
"Clinical Outcome of Stage I/II Melanoma Patients After Selective Sentinel Lymph Node Dissection: Long-Term Follow-Up Results"
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