 |
|
Effect of Multiple–Nodal Basin Drainage on Cutaneous Melanoma
Andrea C. Federico, BA;
Anees B. Chagpar, MD;
Merrick I. Ross, MD;
Robert C. G. Martin, MD;
R. Dirk Noyes, MD;
James S. Goydos, MD;
Peter D. Beitsch, MD;
Marshall M. Urist, MD;
Stephan Ariyan, MD;
Jeffrey J. Sussman, MD;
Kelly M. McMasters, MD, PhD;
Charles R. Scoggins, MD, MBA; for the Sunbelt Melanoma Trial
Arch Surg. 2008;143(7):632-638.
Hypothesis The number of nodal basins draining a primary cutaneous melanoma is not an independent predictor of outcome.
Design Post hoc analysis of patients entered into a randomized, prospective study.
Setting Multi-institutional academic and community medical centers.
Patients Patients aged 18 to 70 years with melanoma 1.0 mm or greater Breslow thickness.
Interventions Wide local excision and sentinel lymph node biopsy were performed on all patients; patients with sentinel lymph node metastases underwent completion lymphadenectomy. Patients with multiple–nodal basin drainage were compared with those with single–nodal basin drainage.
Main Outcome Measures Sentinel lymph node status, locoregional recurrence-free survival, disease-free survival, and overall survival.
Results A total of 2060 patients with single–nodal basin drainage (n = 1709 [83% of cohort]) were included in the analysis, with a median follow-up of 50 months. On univariate analysis, the group with multiple–nodal basin drainage (n = 351) was associated with female sex and primary tumor regression (P < .001). In addition, multiple–nodal basin drainage was associated with truncal primary tumor location (73.2%), while single–nodal basin drainage was more common for extremity tumors (50.9%; P < .001). On multivariate analysis, there were no differences in the rate of sentinel lymph node metastasis, disease-free survival, or overall survival between the groups. Interestingly, locoregional recurrence was significantly worse in the single–nodal basin drainage group (P = .003).
Conclusions Multiple–nodal basin drainage does not confer a worse prognosis for patients with cutaneous melanoma. In fact, single–nodal basin drainage appears to be associated with a greater risk of locoregional recurrence.
Author Affiliations: Division of Surgical Oncology, Department of Surgery, University of Louisville, James Graham Brown Cancer Center and Center for Advanced Surgical Technologies of Norton Hospital, Louisville, Kentucky (Ms Federico and Drs Chagpar, Martin, McMasters, and Scoggins); Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston (Dr Ross); Departments of Surgery, LDS Hospital, Salt Lake City, Utah (Dr Noyes); Cancer Institute of New Jersey, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick (Dr Goydos), Dallas Surgical Group, Dallas, Texas (Dr Beitsch), University of Alabama, Birmingham (Dr Urist); Melanoma Unit of the Yale Cancer Center, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut (Dr Ariyan); and Department of Surgery, University of Cincinnati, Cincinnati, Ohio (Dr Sussman).
Group Information: A list of participating investigators in the Sunbelt Melanoma Trial was published in J Surg Oncol. 2004;86(4):212-223.
|
