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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Early (sentinel lymph node biopsy-guided) versus delayed lymphadenectomy in melanoma patients with lymph node metastases: personal experience and literature meta-analysis

Review published: 2010.

Bibliographic details: Pasquali S, Mocellin S, Campana LG, Bonandini E, Montesco MC, Tregnaghi A, Del Fiore P, Nitti D, Rossi CR.  Early (sentinel lymph node biopsy-guided) versus delayed lymphadenectomy in melanoma patients with lymph node metastases: personal experience and literature meta-analysis. Cancer 2010; 116(5): 1201-1209. [PubMed: 20066719]

Abstract

BACKGROUND: It is debated whether patients with melanoma who undergo lymphadenectomy after a positive sentinel lymph node (SN) biopsy (SNB) have a better prognosis compared with patients who are treated for clinically evident disease.

METHODS: The records of 190 patients with cutaneous melanoma who underwent radical lymph node dissection after a positive SNB (completion lymph node dissection [CLND]; n = 100) or who had clinically evident lymph node metastasis (therapeutic lymph node dissection [TLND]; n = 90) were analyzed. Moreover, the MEDLINE, EMBASE, and Cochrane databases were searched for studies that investigated the survival impact of SNB-guided CLND compared with TLND for clinically evident disease. Standard meta-analysis methods were used to calculate the overall treatment effect across eligible studies.

RESULTS: In the authors' series, tumor characteristics did not differ significantly between patients who underwent CLND and those who underwent TLND. After a median follow-up of 52.6 months, the 5-year overall survival rate did not differ significantly between CLND patients and TLND patients (68.9% vs 50.4%, respectively; log-rank test; P = .17). In contrast, a meta-analysis of 6 studies (n = 2633) that addressed this issue (including the authors' own series) indicated that there was a significantly higher risk of death for patients who underwent TLND compared with that for patients who underwent CLND (hazard ratio, 1.60; 95% confidence interval, 1.28-2.00; P < .0001).

CONCLUSIONS: Although no significant survival difference was observed in either series, the pooling of summary data from all the studies that dealt with this issue suggested that SNB-guided CLND is associated with a significantly better outcome compared with TLND for clinically evident lymph node disease.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 20066719

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