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International Center-Level Variation in Utilization of Completion Lymph Node Dissection and Adjuvant Systemic Therapy for Sentinel Lymph Node-Positive Melanoma at Major Referral Centers.
Broman, Kristy K; Hughes, Tasha M; Bredbeck, Brooke C; Sun, James; Kirichenko, Dennis; Carr, Michael J; Sharma, Avinash; Bartlett, Edmund K; Nijhuis, Amanda A G; Thompson, John F; Hieken, Tina J; Kottschade, Lisa; Downs, Jennifer; Gyorki, David E; Stahlie, Emma; van Akkooi, Alexander; Ollila, David W; O'shea, Kristin; Song, Yun; Karakousis, Giorgos; Moncrieff, Marc; Nobes, Jenny; Vetto, John; Han, Dale; Hotz, Meghan; Farma, Jeffrey M; Deneve, Jeremiah L; Fleming, Martin D; Perez, Matthew; Baecher, Kirsten; Lowe, Michael; Bagge, Roger Olofsson; Mattsson, Jan; Lee, Ann Y; Berman, Russell S; Chai, Harvey; Kroon, Hidde M; Teras, Juri; Teras, Roland M; Farrow, Norma E; Beasley, Georgia M; Hui, Jane Yuet Ching; Been, Lukas; Kruijff, Schelto; Sinco, Brandy; Sarnaik, Amod A; Sondak, Vernon K; Zager, Jonathan S; Dossett, Lesly A.
Afiliación
  • Broman KK; Moffitt Cancer Center, Tampa, FL.
  • Hughes TM; University of South Florida Morsani College of Medicine, Tampa, FL.
  • Bredbeck BC; University of Alabama at Birmingham, Birmingham, AL.
  • Sun J; University of Michigan, Ann Arbor, MI.
  • Kirichenko D; University of Michigan, Ann Arbor, MI.
  • Carr MJ; Moffitt Cancer Center, Tampa, FL.
  • Sharma A; University of South Florida Morsani College of Medicine, Tampa, FL.
  • Bartlett EK; Moffitt Cancer Center, Tampa, FL.
  • Nijhuis AAG; Memorial Sloan Kettering Cancer Center, New York, NY.
  • Thompson JF; Memorial Sloan Kettering Cancer Center, New York, NY.
  • Hieken TJ; Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.
  • Kottschade L; Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.
  • Downs J; Mayo Clinic, Rochester, MN.
  • Gyorki DE; Mayo Clinic, Rochester, MN.
  • Stahlie E; Peter MacCallum Cancer Center, Melbourne, Australia.
  • van Akkooi A; Peter MacCallum Cancer Center, Melbourne, Australia.
  • Ollila DW; Netherlands Cancer institute, Amsterdam, The Netherlands.
  • O'shea K; Netherlands Cancer institute, Amsterdam, The Netherlands.
  • Song Y; University of North Carolina, Chapel Hill, NC.
  • Karakousis G; University of North Carolina, Chapel Hill, NC.
  • Moncrieff M; University of Gothenburg, Gothenburg, Sweden.
  • Nobes J; University of Pennsylvania, Philadelphia, PA.
  • Vetto J; Norfolk and Norwich University Hospital, Norwich, United Kingdom.
  • Han D; Norfolk and Norwich University Hospital, Norwich, United Kingdom.
  • Hotz M; Oregon Health & Science University, Portland, OR.
  • Farma JM; Oregon Health & Science University, Portland, OR.
  • Deneve JL; Fox Chase Cancer Center, Philadelphia, PA.
  • Fleming MD; Fox Chase Cancer Center, Philadelphia, PA.
  • Perez M; University of Tennessee, Memphis, TN.
  • Baecher K; University of Tennessee, Memphis, TN.
  • Lowe M; Emory University, Atlanta, GA.
  • Bagge RO; Emory University, Atlanta, GA.
  • Mattsson J; Emory University, Atlanta, GA.
  • Lee AY; University Medical Center, Groningen, Netherlands.
  • Berman RS; University Medical Center, Groningen, Netherlands.
  • Chai H; NYU Langone Health, New York, NY.
  • Kroon HM; NYU Langone Health, New York, NY.
  • Teras J; Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
  • Teras RM; Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
  • Farrow NE; North Estonia Medical Centre Foundation, Tallinn, Estonia.
  • Beasley GM; North Estonia Medical Centre Foundation, Tallinn, Estonia.
  • Hui JYC; Duke University, Durham, NC.
  • Been L; Duke University, Durham, NC.
  • Kruijff S; University of Minnesota, Minneapolis, MN.
  • Sinco B; Moffitt Cancer Center, Tampa, FL.
  • Sarnaik AA; Moffitt Cancer Center, Tampa, FL.
  • Sondak VK; University of Michigan, Ann Arbor, MI.
  • Zager JS; Moffitt Cancer Center, Tampa, FL.
  • Dossett LA; University of South Florida Morsani College of Medicine, Tampa, FL.
Ann Surg ; 277(5): e1106-e1115, 2023 05 01.
Article en En | MEDLINE | ID: mdl-35129464
OBJECTIVE: The aim of this study was to determine overall trends and center-level variation in utilization of completion lymph node dissection (CLND) and adjuvant systemic therapy for sentinel lymph node (SLN)-positive melanoma. SUMMARY BACKGROUND DATA: Based on recent clinical trials, management options for SLN-positive melanoma now include effective adjuvant systemic therapy and nodal observation instead of CLND. It is unknown how these findings have shaped practice or how these contemporaneous developments have influenced their respective utilization. METHODS: We performed an international cohort study at 21 melanoma referral centers in Australia, Europe, and the United States that treated adults with SLN-positive melanoma and negative distant staging from July 2017 to June 2019. We used generalized linear and multinomial logistic regression models with random intercepts for each center to assess center-level variation in CLND and adjuvant systemic treatment, adjusting for patient and disease-specific characteristics. RESULTS: Among 1109 patients, performance of CLND decreased from 28% to 8% and adjuvant systemic therapy use increased from 29 to 60%. For both CLND and adjuvant systemic treatment, the most influential factors were nodal tumor size, stage, and location of treating center. There was notable variation among treating centers in management of stage IIIA patients and use of CLND with adjuvant systemic therapy versus nodal observation alone for similar risk patients. CONCLUSIONS: There has been an overall decline in CLND and simultaneous adoption of adjuvant systemic therapy for patients with SLN-positive melanoma though wide variation in practice remains. Accounting for differences in patient mix, location of care contributed significantly to the observed variation.
Asunto(s)

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Neoplasias Cutáneas / Ganglio Linfático Centinela / Melanoma Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Revista: Ann Surg Año: 2023 Tipo del documento: Article

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Neoplasias Cutáneas / Ganglio Linfático Centinela / Melanoma Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Revista: Ann Surg Año: 2023 Tipo del documento: Article