In a nutshell
This study evaluated the timing of lymphadenectomy and its impact on the outcome of melanoma patients with lymph node metastasis.
Some background
Among melanoma patients, spread of the cancer to the regional lymph nodes (referred to as lymph node involvement or lymph node metastasis) is known to significantly increase the risk of disease progression and mortality. Lymphadenectomy (the surgical removal of regional lymph nodes) is currently the standard of care for the treatment of melanoma patients with lymph node metastasis, however survival following lymphadenectomy varies. This study evaluated whether the timing of this procedure could influence disease outcomes.
Methods & findings
The study evaluated 1,704 melanoma patients who underwent a lymphadenectomy. 279 patients had immediate therapeutic lymphadenectomy for clinically obvious metastasis to the lymph nodes (for example enlarged and painful nodes) at the time of diagnosis. 502 of the patients underwent a lymph node biopsy and received an immediate lymphadenectomy following a positive result. 214 patients underwent a delayed procedure due to an initial negative biopsy result (which was later found to be positive). The remaining 709 patients did not undergo any lymph node biopsy following diagnosis, and later required delayed therapeutic lymphadenectomy for clinically obvious lymph node metastasis.
Disease-free survival (the length of time after the procedure without signs or symptoms of disease recurrence) was highest among patients receiving a delayed therapeutic lymphadenectomy (82 months). Among patient receiving an immediate lymphadenectomy following a positive biopsy result disease-free survival was 68 months. Disease-free survival averaged 48 months for patients receiving delayed lymphadenectomy due to initially negative biopsy results.
Post-recurrence survival (survival from the time of first recurrence after the procedure) was longest for patients receiving an immediate lymphadenectomy following a positive biopsy result at the time of diagnosis (14 months). Patients receiving a delayed therapeutic lymphadenectomy and those receiving an immediate therapeutic lymphadenectomy experienced an average post-recurrence survival of 9 months. Delayed lymphadenectomy due to initially negative biopsy results showed an average post-recurrence survival of 8 months.
Overall survival from the time of diagnosis was not reached for patients receiving an immediate lymphadenectomy following a positive biopsy result, due to the short time-span of the study. For delayed therapeutic lymphadenectomy average overall survival was estimated at 101 months, followed by delayed lymphadenectomy at 71 months.
The bottom line
This study concluded that sentinel lymph node biopsy at the time of diagnosis and an immediate lymphadenectomy following a positive biopsy result is associated with prolonged disease-free and post-recurrence survival.
The fine print
The study carries a substantial bias risk due to its retrospective nature and the many factors not accounted for.
Published By :
Annals of Surgical Oncology
Date :
Sep 20, 2013
