Therapeutic Lymph Node Dissection in Melanoma: Different Prognosis for Different Macrometastasis SitesReport as inadecuate

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Annals of Surgical Oncology

, Volume 19, Issue 12, pp 3913–3918

First Online: 17 May 2012Received: 16 April 2012


BackgroundThe prognostic significance of primary tumor location, especially the poor prognosis for melanomas in the scalp and neck region, is well established. However, the prognosis for different sites of nodal macrometastasis has never been studied. This study investigated the prognostic value of the location of macrometastasis in terms of recurrence and survival rates after therapeutic lymph node dissection TLND.

MethodsAll consecutive FDG-PET-staged melanoma patients with palpable and cytologically proven lymph node metastases operated at our clinic between 2003 and 2011 were included. Disease-free survival and disease-specific survival DSS were compared for nodal metastases in the groin, axilla, and neck regions by multivariable analysis.

ResultsA total of 149 patients underwent TLND; there were 70 groin 47 %, 57 axillary 38 %, and 22 neck 15 % dissections. During a median follow-up of 18 range 1–98 months, 102 patients 68 % developed recurrent disease. Distant recurrence was the first sign of progressive disease in 78, 76, and 55 % of the groin, axilla, and neck groups, respectively p = 0.26. Low involved-total lymph nodes L-N ratio p < 0.001 and absence of extranodal growth pattern p = 0.05 were independent predictors of a longer disease-free survival. For DSS, neck site of nodal metastasis p = 0.02 and low L-N ratio p < 0.001 were independent predictors of long survival. The estimated 5-year DSS for the groin, axilla, and neck sites was 28, 34, and 66 %, respectively.

ConclusionsThere seems significantly longer DSS after TLND for nodal macrometastases in the neck compared to axillary and groin sites, although larger series should confirm this finding.

Selected as the 2012 Best Clinical Research Poster by meeting attendees at the 65th Annual Cancer Symposium of the Society of Surgical Oncology, Orlando, FL.

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Author: K. P. Wevers - E. Bastiaannet - H. P. A. M. Poos - R. J. van Ginkel - J. T. Plukker - H. J. Hoekstra



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