July 21, 2015
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Early SLNB may worsen melanoma-specific survival, DFS

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A sentinel lymph node biopsy within 40 days of tumor excision appeared to worsen survival in patients with cutaneous melanoma compared with a delayed biopsy, according to study results.

This association was especially pronounced in patients with a negative sentinel lymph node biopsy (SLNB) or who had absence of regression in the primary tumor.

A shorter interval between tumor excision and nodal biopsy appeared to have an adverse effect on the efficiency of antitumor immune response following the excision, according to the researchers.

Antonio Tejera-Vaquerizo, MD

Antonio Tejera-Vaquerizo

“Currently, SLNB is a standard procedure in melanoma management,” Antonio Tejera-Vaquerizo, MD, of the department of dermatology in the Institute of Biomedicine of Malaga at the Hospital Universitario Virgen de la Victoria in Spain, told HemOnc Today. “There is usually a delay between excision of the primary tumor and the performance of SLNB, attributable to multiple factors including surgical scheduling, preoperative assessment, etc. The influence of this delay in prognosis remains unclear to date. The objective of the study was to evaluate in a large series of patients the effects on survival of the delay between excision of a primary melanoma and performance of sentinel-node biopsy.”

Tejera-Vaquerizo and colleagues conducted this observational, retrospective study composed of 1,963 patients (median age, 53 years; range, 41-65; 50.7% men) who were treated at one of four hospitals in Spain and France between 1997 and 2012. Patients had a single primary melanoma (stage I or II) and underwent SLNB within 120 days of excision. Researchers categorized patients as undergoing SLNB within 40 days after the excision (n = 634) or after 40 days (n = 1,329).

Patients with a delay time of 40 days or less had a higher frequency of ulceration compared to those who had a delay time of greater than 40 days (38.6% vs. 32.1%; P = .014).

After a median follow-up of 46 months (range, 20-77), 10.6% of the patients had died and 18.7% developed a recurrence.

A greater proportion of patients who underwent SLNB after a delay of more than 40 days achieved 5-year DFS (80.1% vs. 73.8%; P < .084) and 5-year melanoma-specific survival (89.5% vs. 82%; P = .0002) compared with patients who underwent early SLNB.

The primary prognostic factor for survival in the total population was sentinel node positivity. A greater proportion of patients with a negative biopsy achieved 5-year DFS (85.5% vs. 56%) and 5-year melanoma-specific survival (92.4% vs. 71.4%) compared with patients with a positive biopsy.

Overall, a delay time of 40 days or less (HR = 1.7; 95% CI, 1.2-2.5), Breslow thickness 2 mm or greater (HR ˃ 3.7; 95% CI, 1.4-10.7), ulceration (HR = 1.6; 95% CI, 1.1-2.3), sentinel node metastases (HR = 2.9; 95% CI, 1.9-4.2) and a head or neck location were independently associated with worse melanoma-specific survival.

"After analyzing nearly 2,000 patients from various referral centers for the management of patients with melanoma in Spain and France, it has shown that the delay in [performing] the SLNB did not increase the mortality of these patients,” Tejera-Vaquerizo said. “Paradoxically, we found that the sooner this procedure is performed, the worse the mortality. A stratified analysis showed that the effect of delay time was at the expense of the patients with a negative SLNB. Consequently, we can say that an early SLNB is associated with a worse prognosis in melanoma patients.”

The investigators acknowledged the retrospective nature of collecting prospective data — which could lead to selection bias — may be a limitation to these findings. The data analyzed also were not originally collected for the purpose of this study, which may also contribute toward selection bias. Further, 30.2% of the patients enrolled were lost to follow-up, which researchers noted is a high proportion of the population.

Yet, the researchers believe that their findings raise important questions about the prognostic nature of the time delay for SLNB.

“What is clear is that a delay in the procedure did not worsen the prognosis in any case,” the researchers wrote. “Further studies will also need to determine the underlying aetiologic and pathogenic mechanisms in order to guide optimal management strategies for our patients.” – by Anthony SanFilippo

For more information:

Antonio Tejera-Vaquerizo, MD, can be reached at antoniotejera@aedv.es.

Disclosure: The researchers report no relevant financial disclosures.