Document Type
Article
Publication Date
6-8-2017
Abstract
BACKGROUND: Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear.
METHODS: In an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Secondary end points included disease-free survival and the cumulative rate of nonsentinel-node metastasis.
RESULTS: Immediate completion lymph-node dissection was not associated with increased melanoma-specific survival among 1934 patients with data that could be evaluated in an intention-to-treat analysis or among 1755 patients in the per-protocol analysis. In the per-protocol analysis, the mean (±SE) 3-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86±1.3% and 86±1.2%, respectively; P=0.42 by the log-rank test) at a median follow-up of 43 months. The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68±1.7% and 63±1.7%, respectively; P=0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92±1.0% vs. 77±1.5%; P
CONCLUSIONS: Immediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases. (Funded by the National Cancer Institute and others; MSLT-II ClinicalTrials.gov number, NCT00297895 .).
Recommended Citation
Faries, Mark B.; Thompson, John F.; Cochran, Alistair J.; Andtbacka, Robert H.; Mozzillo, Nicola; Zager, Jonathan S.; Jahkola, Tiina; Bowles, Tawnya L.; Testori, Alessandro; Beitsch, Peter D.; Hoekstra, Harald J.; Moncrieff, Marc; Ingvar, Christian; Wouters, Michel W.J.M.; Sabel, Michael S.; Levine, Edward A.; Agnese, Doreen; Henderson, Michael; Dummer, Reinhard; Rossi, Carlo R.; Neves, Rogerio I.; Trocha, Steven D.; Wright, Frances; Byrd, David R.; Matter, Maurice; Hsueh, Eddy; MacKenzie-Ross, Alastair; Johnson, Douglas B.; Terheyden, Patrick; Berger, Adam C.; Huston, Tara L.; Wayne, Jeffrey D.; Smithers, B. Mark; Neuman, Heather B.; Schneebaum, Schlomo; Gershenwald, Jeffrey E.; Ariyan, Charlotte E.; Desai, Darius C.; Jacobs, Lisa; McMasters, Kelly M.; Gesierich, Anja; Hersey, Peter; Bines, Steven D.; Kane, John M.; Barth, Richard J.; McKinnon, Gregory; Farma, Jeffrey M.; Schultz, Erwin; Vidal-Sicart, Sergi; Hoefer, Richard A.; Lewis, James M; Scheri, Randall; Kelley, Mark C.; Nieweg, Omgo E.; Noyes, R. Dirk; Hoon, Dave S.B.; Wang, He-Jing; Elashoff, David A.; and Elashoff, Robert M., "Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma." (2017). Department of Surgery Faculty Papers. Paper 149.
https://jdc.jefferson.edu/surgeryfp/149
PubMed ID
28591523
Comments
This article has been peer reviewed. It is the author’s final published version in New England Journal of Medicine
Volume 376, Issue 23, June 2017, Pages 2211-2222.
The published version is available at DOI: 10.1056/NEJMoa1613210. Copyright © Massachusetts Medical Society.