Sentinel Lymph Node Biopsy for T1b Melanoma: Balancing Prognostic Value and Cost.
Ann Surg Oncol
; 27(13): 5248-5256, 2020 Dec.
Article
in En
| MEDLINE
| ID: mdl-32514805
ABSTRACT
BACKGROUND:
The purpose of this study is to report the additional prognostic information and cost associated with sentinel lymph node biopsy (SLNB) for patients with T1b melanoma. PATIENTS ANDMETHODS:
An institutional database was queried for patients with T1b melanoma (0.8-1.0 mm or < 0.8 mm with ulceration) with at least 5 years of follow-up. Results of SLNB, completion lymphadenectomy (CLND), recurrence, and melanoma-specific survival (MSS) were assessed. Institutional costs of melanoma care were converted to Medicare proportional dollars. A Markov model was created to estimate long-term costs.RESULTS:
Among the total 392 patients, 238 underwent SLNB. Median follow-up was 10.5 years. SLNB was positive in 19 patients (8.0%). Patients who underwent SLNB had higher 10-year nodal recurrence-free survival (98.6% vs. 91.2%, p < 0.001) but not MSS (94.4% vs. 93.2%, p = 0.55). Ulceration (HR 4.7, p = 0.022) and positive sentinel node (HR 11.5, p < 0.001) were associated with worse MSS. Estimates for 5-year costs reflect a fourfold increase in total costs of care associated with SLNB. However, a treatment plan that forgoes adjuvant therapy for resected stage IIIA melanoma but offers systemic therapy for a node-basin recurrence would nullify the additional cost of SLNB.CONCLUSIONS:
SLNB is prognostic for T1b melanoma. Its impact on the overall cost of melanoma care is intimately tied to systemic therapy in the adjuvant and recurrent settings.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Skin Neoplasms
/
Sentinel Lymph Node
/
Melanoma
Type of study:
Health_economic_evaluation
/
Observational_studies
/
Prognostic_studies
Limits:
Aged
/
Humans
Country/Region as subject:
America do norte
Language:
En
Year:
2020
Type:
Article