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Patterns of Recurrence and Survival After Lymphadenectomy in Melanoma Patients: Clarifying the Effects of Timing of Surgery and Lymph Node Tumor Burden

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Melanoma patients with lymph node (LN) metastases have variable survival after lymphadenectomy. This study investigates whether lymphadenectomy at different times in the course of disease progression influences disease-free survival (DFS; time from primary diagnosis to first recurrence after lymphadenectomy), post recurrence survival (PRS; time from first recurrence after lymphadenectomy to death), and overall survival (OS; time from diagnosis to death).

Methods

Between 1992 and 2010, a total of 1,704 patients underwent lymphadenectomy; 502 underwent immediate completion lymphadenectomy (ICL) after positive sentinel node biopsy (SNB), 214 had delayed completion lymphadenectomy (DCL) for regional recurrence after positive SNB with no ICL or after an earlier false-negative SNB, 709 had no SNB and later required delayed therapeutic lymphadenectomy (DTL) for clinically evident metastasis, and 279 had immediate therapeutic lymphadenectomy (ITL) for clinically positive LNs at primary melanoma diagnosis.

Results

Median DFS for ICL, DCL, DTL, and ITL was 68, 48, 82, and 16 months, respectively (p < 0.001). Median PRS for ICL, DCL, DTL, and ITL was 14, 8, 9, and 9 months, respectively (p < 0.001). Median OS for ICL was not reached whilst for DCL, DTL, and ITL it was 71, 101, and 29 months, respectively (p < 0.001). Extranodal spread and tumor, node, metastasis classification system N stage were the only significant prognostic factors for OS within each group. ICL patients had significantly improved DFS (p = 0.005) and OS (p = 0.012) beyond 5 years compared to DTL patients.

Conclusions

Variable outcomes after lymphadenectomy were observed with different timing of surgery and LN tumor burden. ICL patients had the best outcome.

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Acknowledgment

A.J.S.’s research is supported by the Friends of the Mater Foundation, North Sydney, NSW, Australia. S.P. was a research fellow at Melanoma Institute Australia and was supported by the University of Padova, Padova, Italy. J.F.T.’s research is supported by the Melanoma Foundation of the University of Sydney.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Sydney Medical School, The University of Sydney, Sydney, Australia

    Andrew J. Spillane MD FRACS, Lauren E. Haydu BSCHE, MIPH & John F. Thompson MD, FRACS, FACS

  2. Melanoma Institute Australia, Sydney, Australia

    Andrew J. Spillane MD FRACS, Sandro Pasquali MD, Lauren E. Haydu BSCHE, MIPH & John F. Thompson MD, FRACS, FACS

  3. The Mater Hospital, North Sydney, Australia

    Andrew J. Spillane MD FRACS & John F. Thompson MD, FRACS, FACS

  4. Royal Prince Alfred Hospital, Camperdown, Australia

    Andrew J. Spillane MD FRACS & John F. Thompson MD, FRACS, FACS

  5. Royal North Shore Hospital, St. Leonards, Australia

    Andrew J. Spillane MD FRACS

Authors
  1. Andrew J. Spillane MD FRACS
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  2. Sandro Pasquali MD
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  3. Lauren E. Haydu BSCHE, MIPH
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  4. John F. Thompson MD, FRACS, FACS
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Corresponding author

Correspondence to Andrew J. Spillane MD FRACS.

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Spillane, A.J., Pasquali, S., Haydu, L.E. et al. Patterns of Recurrence and Survival After Lymphadenectomy in Melanoma Patients: Clarifying the Effects of Timing of Surgery and Lymph Node Tumor Burden. Ann Surg Oncol 21, 292–299 (2014). https://doi.org/10.1245/s10434-013-3253-6

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  • DOI: https://doi.org/10.1245/s10434-013-3253-6

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