Association of Sentinel Lymph Node Biopsy With Survival for Head and Neck Melanoma

Abstract

Importance Sentinel lymph node biopsy (SLNB) provides prognostic information for melanoma; however, a survival benefit has not been demonstrated. Objective To assess the association of SLNB with survival for head and neck melanoma (HNM). Design Propensity score-matched retrospective cohort study using the Surveillance Epidemiology and End Results (SEER) database to compare patients with HNM initially treated with SLNB versus nodal observation. Setting United States population Patients Melanoma arising in head and neck subsites meeting current recommendations for SLNB, treated during the years 2004-2011 with either a) SLNB +/− neck dissection, or b) no SLNB or neck dissection. Intervention: SLNB +/− neck dissection Main Outcome Disease-specific survival (DSS) estimates based on the Kaplan-Meier method, and Cox proportional-hazards modeling to compare survival outcomes between matched-pair cohorts Results 7266 HNM patients meeting study criteria were identified from the SEER database. Matching of treatment cohorts was performed utilizing propensity scores modeled on 10 covariates known to be associated with SLNB treatment or melanoma survival. Cohorts were stratified by tumor thickness (thin: >0.75-1mm Breslow depth, intermediate: >1-4mm, and thick: >4mm) and exactly-matched within five age categories. In the intermediate-thickness cohort, 2808 HNM patients were matched and balanced by propensity score for SLNB treatment; the 5-year DSS estimate for those treated by SLNB was 89% vs. 88% for nodal observation (log-rank p=0.30). The hazard ratio for melanoma-specific death was 0.87 for those undergoing SLNB (95% CI 0.66-1.14, p=0.31). In each of the other cohorts analyzed, including the thin, thick, and overall cohorts, no significant difference in DSS was demonstrated. Conclusions This SEER cohort analysis demonstrates no significant association between SLNB and improved disease survival for patients with HNM.

Risk and Survival of Patients with Head and Neck Cutaneous Melanoma: National Perspective

“…The prognostic and therapeutic values of lymph node biopsy have been widely examined with conflicting results. Sperry et al [26] , using the Surveillance Epidemiology and End Results (SEER) database, reported no disease-specific survival benefit was associated with performance of lymph node biopsy in patients with head and neck melanoma and across all tumor thickness groups. Tanis et al [27] , in their systematic review that examined results from multiple studies including the Multicenter Selective Lymphadenectomy Trial-I and other prominent retrospective cohort studies, also concluded that there is no definitive survival advantage of sentinel node biopsy in patients with clinically node-negative head and neck melanoma of intermediate thickness.…”

Effect of Angiotensin System Inhibitors on Survival in Patients Receiving Chemotherapy for Advanced Non–Small-Cell Lung Cancer

“…A threshold of 0.10 was used to indicate imbalance in the baseline covariates. 21–30 Refinements of the matching model were made iteratively until balance was achieved. Final covariates included in CP propensity score were age at diagnosis, race/ethnicity, sex, education (census data proxies ranked into quintiles), chronic obstructive pulmonary disease (COPD), cardiovascular disease (includes diagnoses of cardiovascular disease, congestive heart failure and myocardial infarction), peripheral vascular disease (PVD), diabetes, other comorbid diseases (including liver disease, plegia, renal disease, peptic ulcer disease, and rheumatic disease), health plan site, and other anti-hypertensive medications (defined as a dispense of any other [i.e., non-ASI] anti-hypertensive medication during the study period).…”

“…31 Using Cox regression modeling with a robust sandwich variance estimator on the matched sample pairs, we estimated relative hazard ratios (HRs) and their 95% confidence intervals (CIs) to evaluate the effect of ASI receipt on OS. 21–30 …”

Clinical outcomes of various continued antiplatelet therapies in patients who were administered DAPT following the implantation of drug-eluting stents and developed gastrointestinal hemorrhage

“…Two-tailed Fisher's exact test or χ 2 test was used to compare categorical variables. Survival analysis was used to compare patients' survival data and was performed using the Log-rank, Breslow and Tarone-Ware methods (6)(7)(8). Data were presented as the mean ± standard deviation.…”