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Completion Lymph Node Dissection for Melanoma Before and After the Multicenter Selective Lymphadenectomy Trial-II in the United States

  • Melanoma
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Abstract

Background

The Multicenter Selective Lymphadenectomy Trial-II (MSLT-II) revealed completion lymph node dissection (CLND) after positive sentinel lymph node biopsy (SLNB) did not improve melanoma-specific survival compared with surveillance. Given these findings and the morbidity associated with CLND, this study investigated trends in rates and predictors of CLND after MSLT-II.

Methods

Analysis of the National Cancer Database was performed for all patients aged ≥18 years with melanoma and a positive SLNB for 2012–2019. Rates of CLND before and after publication of MSLT-II were identified and logistic regression used to identify factors associated with CLND.

Results

Patients undergoing CLND declined from 55.9% pre-MSLT-II (n = 9725) to 19.5% post-MSLT-II (n = 9419) (odds ratio [OR] 0.32, 95% confidence interval [CI] 0.29–0.35). CLND was less likely in females (OR 0.83; 95% CI 0.78–0.89), older patients (vs. 18–39 yr; 40–64 yr OR 0.80, 95% CI 0.65–0.98; 65–79 yr OR 0.67, 95% CI 0.53–0.84; >80 yr OR 0.38, 95% CI 0.30–0.49), sicker patients (Deyo category ≥2 OR 0.85, 95% CI 0.73–0.99), thinner primary lesions (vs. 0.01–0.79 mm; 1.01–4.00 mm OR 1.16, 95% CI 1.01–1.33; ≥4.01 mm OR 1.31, 95% CI 1.08–1.59), patients from metro areas (Rural OR 1.31, 95% CI 1.00–1.70; Urban OR 1.15, 95% CI 1.03–1.29), and those treated at lower-volume centers (vs. lowest-volume; highest-volume OR 1.31, 95% CI 1.14–1.50; high-volume OR 1.40, 95% CI 1.24–1.57).

Conclusions

MSLT-II has impacted clinical care; however, male gender, thicker lesions, rural/urban residence, younger age, fewer comorbidities, and treatment at higher-volume centers confer a greater likelihood of undergoing CLND. Further investigations should focus on whether these populations benefit from more aggressive surgical care.

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Acknowledgement

The data used in the study are derived from de-identified NCDB files. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigators.

Funding

This funding was provided by NIH Training Grant, T32 CA160003.

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Authors and Affiliations

  1. Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA

    Jennifer T. Castle MD, Brittany E. Levy MD, Emily F. Marcinkowski MD, FACS & Erin E. Burke MD, MS

  2. Department of Biostatistics, University of Kentucky, Lexington, KY, USA

    Reuben Adatorwovor PhD & Jerod L. Stapleton PhD

  3. Division of Surgical Oncology, University of Kentucky, Lexington, KY, USA

    Emily F. Marcinkowski MD, FACS & Erin E. Burke MD, MS

  4. Department of Health, Behavior and Society, University of Kentucky, Lexington, KY, USA

    Allison Merritt MPH

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  1. Jennifer T. Castle MD
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Correspondence to Erin E. Burke MD, MS.

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Jennifer T. Castle, MD, is supported by the NIH Training Grant (T32 CA160003). There are no other disclosures to report for this and the other authors.

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Castle, J.T., Adatorwovor, R., Levy, B.E. et al. Completion Lymph Node Dissection for Melanoma Before and After the Multicenter Selective Lymphadenectomy Trial-II in the United States. Ann Surg Oncol 30, 1184–1193 (2023). https://doi.org/10.1245/s10434-022-12745-0

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