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Sentinel lymph node biopsy versus observation in thick melanoma: A multicenter propensity score matching study.

Aram BoadaAntonio Tejera-VaquerizoSimone RiberoSusana Puig SardàDavid Moreno-RamírezMiguel Ángel Gallego DescalzoMaria Teresa FierroPietro QuaglinoCristina CarreraJosep Malvehy GuileraSergi Vidal-SicartAntoni BennássarRamón RullLlúcia AlósCelia RequenaIsidro BolumarVíctor TravesÁngel PlaMaria-Teresa Fernandez-FiguerasCarlos FerrándizIciar PascualJosé L ManzanoMarina Sánchez-LucasPol Giménez-XavierLara FerrándizEduardo Nagore
Published in: International journal of cancer (2017)
The clinical value of sentinel lymph node (SLN) biopsy in thick melanoma patients (Breslow >4 mm) has not been sufficiently studied. The aim of the study is to evaluate whether SLN biopsy increases survival in patients with thick cutaneous melanoma, and, as a secondary objective, to investigate correlations between survival and lymph node status. We included 1,211 consecutive patients with thick melanomas (>4 mm) registered in the participating hospitals' melanoma databases between 1997 and 2015. Median follow-up was 40 months. Of these patients, 752 were matched into pairs by propensity scores based on sex, age, tumor location, histologic features of melanoma, year of diagnosis, hospital and adjuvant interferon therapy. The SLN biopsy vs. observation was associated with better DFS [adjusted hazard ratio (AHR), 0.74; 95% confidence interval (CI) 0.61-0.90); p = 0.002] and OS (AHR, 0.75; 95% CI, 0.60-0.94; p = 0.013) but not MSS (AHR, 0.84; 95% CI, 0.65-1.08; p = 0.165). SLN-negative patients had better 5- and 10-year MSS compared with SLN-positive patients (65.4 vs. 51.9% and 48.3 vs. 38.8%; p = 0.01, respectively). As a conclusion, SLN biopsy was associated with better DFS but not MSS in thick melanoma patients after adjustment for classic prognostic factors. SLN biopsy is useful for stratifying these patients into different prognostic groups.
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