Sentinel lymph node biopsy versus observation in thick melanoma: A multicenter propensity score matching study

Aram Boada, Antonio Tejera‐Vaquerizo, Simone Ribero, Susana Puig, David Moreno‐Ramírez, Miguel A. Descalzo‐Gallego, María T. Fierro, Pietro Quaglino, Cristina Carrera, Josep Malvehy, Sergi Vidal‐Sicart, Antoni Bennássar, Ramón Rull, Llucìa Alos, Celia Requena, Isidro Bolumar, Víctor Traves, Ángel Pla, María T. Fernández‐Figueras, Carlos Ferrándiz, Iciar Pascual, José L. Manzano, Marina Sánchez‐Lucas, Pol Giménez‐Xavier, Lara Ferrandiz, Eduardo Nagore

The clinical value of sentinel lymph node (SLN) biopsy in thick melanoma patients (Breslow >4 mm) has not been sufficiently studied. The aim of the study is to evaluate whether SLN biopsy increases survival in patients with thick cutaneous melanoma, and, as a secondary objective, to investigate correlations between survival and lymph node status. We included 1211 consecutive patients with thick melanomas (>4 mm) registered in the participating hospitals' melanoma databases between 1997 and 2015. Median follow-up was 40 months. Of these patients, 752 were matched into pairs by propensity scores based on sex, age, tumor location, histologic features of melanoma, year of diagnosis, hospital, and adjuvant interferon therapy. The SLN biopsy vs. observation was associated with better DFS (adjusted hazard ratio [AHR], 0.74; 95% confidence interval [CI] 0.61-0.90); P = .002) and OS (AHR, 0.75; 95% CI, 0.60-0.94; P = .013) but not MSS (AHR, 0.84; 95% CI, 0.65-1.08; P = .165). SLN-negative patients had better 5- and 10-year MSS compared to SLN-positive patients (65.4% vs. 51.9% and 48.3% vs 38.8%; p=0.01, respectively). As a conclusion, SLN biopsy was associated with better DFS but not MSS in thick melanoma patients after adjustment for classic prognostic factors. SLN biopsy is useful for stratifying these patients into different prognostic groups. This article is protected by copyright. All rights reserved.