Recurrence factors in patients with cutaneous melanoma and positive sentinel lymph node treated in a single reference unit in Buenos Aires.

INTRODUCTION: Although therapeutic advances have improved results of cutaneous melanoma (CM), sentinel node-positive patients still have substantial risk to develop recurrent disease. We aim to investigate prognostic indicators associated with disease recurrence in positive-sentinel lymph node biopsy (SLNB) patients in a Latin-American population. METHODS: Retrospective analysis of CM patients and positive-SLNB (2010-2020). Patients were divided into two groups: Group A (completion lymph node dissection, CLND), Group B (active surveillance, AS). Association of demographics, tumor data and SLN features with recurrence-free (RFS), distant metastases-free (DMFS) and melanoma specific (MSS) survival was analyzed. RESULTS: Of 205 patients, 45 had a positive SLNB; 27(60%) belonged to Group A and 18(40%) to Group B. With a median follow-up of 36 months, 16 patients (12 in Group A and 4 in Group B) developed recurrent disease and estimated 5-yr RFS at any site was 60% (CI95%, 0.39 - 0.77) (44.5% in CLND group vs. 22% in AS group; P = 0.20). Estimated 5-yr DMFS and MSS: 65% (CI 95%, 0.44 - 0.81) and 73% (CI 95%, 0.59 - 0.89) with no differences between groups (p = 0.41 and 0.37, respectively). Independent predictors of poorer MSS were extranodal extension (ENE) and MaxSize > 2 mm of melanoma deposit in SLN. Factors independently associated with DMFS: Breslow depth > 2 mm, ENE, number (≥ 2) of positive SN and CLND status. CONCLUSION: Primary tumor and SN features in melanoma provide important prognostic information that help optimize prognosis and clinical management. AS is now the preferred approach for most positive-SLNB CM patients.

Introducción: Si bien los avances terapéuticos han permitido mejorar los resultados del melanoma cutáneo (MC), los pacientes con ganglio centinela positivo (BGCP) aún tienen riesgo elevado de desarrollar recurrencia de la enfermedad. Nuestro objetivo fue investigar indicadores pronósticos asociados a dicho evento en una población latinoamericana. Métodos: Análisis retrospectivo de pacientes con MC y BGCP entre 2010-2020. Los pacientes se dividieron en 2 grupos: Grupo A (linfadenectomía terapéutica) y Grupo B (Vigilancia activa, VA). Se analizaron datos demográficos, tumorales y características del GC junto con sobrevidalibre de recurrencia (SLR), libre de metástasis a distancia (SLMD) y específica de melanoma (SEM). Resultados: De 205 pacientes, 45 presentaron BGCP; 27 (60%) perteneció al Grupo A y 18 (40%) al Grupo B. Con una mediana de seguimiento de 36 meses, 16 pacientes (12 en Grupo A y 4 en Grupo B) desarrollaron enfermedad recurrente con una SLR a 5 años de 60% (IC95%: 0.39-0.77) (44.5% en Grupo B vs. 22% en Grupo A; P = 0.20). Las SLMD y SEM estimadas a 5 años fueron de 65% (CI 95%, 0.44 ­ 0.81) y 73% (CI 95%, 0.59 ­ 0.89) sin diferencias entre ambos grupos (p = 0.41 y 0.37, respectivamente). Los predictores independientes de peor SEM fueron: extensión extranodal (ENE) y MaxSize > 2mm de depósito tumoral en GC. Los factores asociados de forma independiente con SLMD fueron Breslow > 2mm, ENE, número (≥ 2) de GC positivos y el status (positividad) de la linfadenectomía. Conclusión: Características del tumor primario y del GC brindan información importante que ayuda a optimizar el pronóstico y manejo clínico de los pacientes con MC. La VA es actualmente el abordaje de elección para la mayoría de los pacientes con BGCP.

Role of sentinel lymph node biopsy for cutaneous melanoma in elderly patients: preliminary results in a Latin-American population.

INTRODUCTION: In melanoma, lymph node status constitutes the most important prognostic factor among patients with locoregional disease. It has been postulated that elderly patients present less metastatic involvement in sentinel lymph node (SLN). Our objective was to analyse the results and evolution of patients ≥ 70 years-old with cutaneous melanoma in whom sentinel lymph node biopsy (SLNB) was carried out. METHODS: Retrospective analysis of 194 patients with primary CM who had a SLNB between 2005 and 2020 was included. Demographic and tumour data, SLN status, recurrence rate, morbidity and evolution were evaluated. Patients were divided into two groups according to age: Group 1 (<70 years old) and Group 2 (≥70 years old). RESULTS: One hundred and fifty patients were included in Group 1 and 44 patients in Group 2. Median Breslow thickness was 1.7 mm in Group 1 and of 2 mm in Group 2 (p = 0.015).Forty-seven patients had positive SLNB; 38 (25%) belonged to Group 1 and 9 (20.5%) to Group 2 (p = 0.55). Recurrence was found in 34 patients: 25 belonging to Group 1 and 9 corresponding to Group 2 (p = 0.65). Morbidity was of 4% in Group 1 and 9% in Group 2 (p = 0.23). With an average follow-up of 30.6 months, 5-year overall survival was of 87% in Group 1 and of 63% in Group 2 (p = 0.04). CONCLUSION: Advanced age was not associated with differences regarding positivity of SLN and recurrence but difference in overall survival was observed. According to our results and the low morbidity rate, we consider SLNB should not be omitted in such age group, since it improves staging and gives the possibility to evaluate adjuvant treatment.