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

  • Melanoma
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Abstract

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.

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Funding

This study was funded by the National Institutes of Health (R01CA189163).

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Authors and Affiliations

  1. John Wayne Cancer Institute, Santa Monica, CA, USA

    Abhineet Uppal MD, Stacey Stern MS, Leland Foshag MD & Manabu Fujita MD

  2. Melanoma Institute Australia and The University of Sydney, Sydney, NSW, Australia

    John F. Thompson MD & Omgo E. Nieweg MD, PhD

  3. University of Naples, Naples, Italy

    Nicola Mizzollo MD

  4. Universitair Medisch Centrum Groningen, Groningen, The Netherlands

    Harald J. Hoekstra MD

  5. New York University School of Medicine, New York, NY, USA

    Daniel F. Roses MD

  6. H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Vernon K. Sondak MD

  7. Sutter Health, San Francisco, CA, USA

    Mohammed Kashani-Sabet MD

  8. Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia

    Brendon J. Coventry MD, PhD

  9. University of California Los Angeles, Los Angeles, CA, USA

    Alistair J. Cochran MD, Myung Sim-Shin PhD, David Elashoff PhD & Robert M. Elashoff PhD

  10. Cedars-Sinai Medical Center, The Angeles Clinic and Research Institute, Los Angeles, CA, USA

    Mark B. Faries MD

Authors
  1. Abhineet Uppal MD
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  2. Stacey Stern MS
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  3. John F. Thompson MD
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  4. Leland Foshag MD
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  5. Nicola Mizzollo MD
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  6. Omgo E. Nieweg MD, PhD
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  7. Harald J. Hoekstra MD
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  8. Daniel F. Roses MD
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  9. Vernon K. Sondak MD
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  10. Mohammed Kashani-Sabet MD
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  11. Brendon J. Coventry MD, PhD
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  12. Alistair J. Cochran MD
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  13. Manabu Fujita MD
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  14. Myung Sim-Shin PhD
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  15. David Elashoff PhD
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  16. Robert M. Elashoff PhD
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  17. Mark B. Faries MD
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Corresponding author

Correspondence to Mark B. Faries MD.

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Disclosures

Mark B. Faries has served on advisory boards for Array Bioscience, Bristol-Myers Squibb, Novartis, Castle Bioscience and Pulse Bioscience, and is a consultant for Delcath Systems. Vernon K. Sondak has served on advisory boards for Merck, Bristol-Meyers Squibb, Novartis and Regeneron, as well as data safety monitor boards for Bristol-Meyers Squibb, Array Bioscience, Novartis, Polynoma and Pfizer. Alistair J. Cochran has received National Institutes of Health grant funding related to this manuscript. Abhineet Uppal, Stacey Stern, John F. Thompson, Leland Foshag, Nicola Mizzollo, Omgo E. Nieweg, Harald J. Hoekstra, Daniel F. Roses, Mohammed Kashani-Sabet, Brendon J. Coventry, Manabu Fujita, Myung Sim-Shin, David Elashoff, and Robert M. Elashoff have no conflicts of interest to declare.

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Uppal, A., Stern, S., Thompson, J.F. et al. Regional Node Basin Recurrence in Melanoma Patients: More Common After Node Dissection for Macroscopic Rather than Clinically Occult Nodal Disease. Ann Surg Oncol 27, 1970–1977 (2020). https://doi.org/10.1245/s10434-019-08086-0

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  • DOI: https://doi.org/10.1245/s10434-019-08086-0

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