Time interval between diagnostic excision-biopsy of a primary melanoma and sentinel node biopsy: effects on the sentinel node positivity rate and survival outcomes
El Sharouni, Mary-Ann; Scolyer, Richard A; van Gils, Carla H; Ch'ng, Sydney; Nieweg, Omgo E; Pennington, Thomas E; Saw, Robyn P M; Shannon, Kerwin; Spillane, Andrew; Stretch, Jonathan; Witkamp, Arjen J; Sigurdsson, Vigfús; Thompson, John F; van Diest, Paul J; Lo, Serigne N
(2022) European Journal of Cancer, volume 167, pp. 123 - 132
(Article)
Abstract
INTRODUCTION: The optimal time interval between diagnostic excision of a primary cutaneous melanoma and sentinel node (SN) biopsy is unknown. The current study sought to determine whether this interval influenced the SN-positivity rate, recurrence or survival. METHODS: Data collected from 2004 to 2014 for a Dutch population-based cohort of patients
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with melanoma who underwent SN biopsy (SNB) within 100 days of initial diagnosis (n = 7660) and for a similarly specified cohort from a large Australian melanoma treatment centre (n = 3478) were analysed. Time to SNB was analysed continuously (in weeks) and categorically (per month). The effects of SNB timing on SN-positivity were assessed using multivariable logistic regression, and its effects on recurrence-free survival (RFS) and overall survival (OS) were assessed using Cox proportional hazard regression analyses. Advanced modelling using a multivariable Cox model with penalised splines for modelling the continuous effects of time to SNB on RFS and OS was also performed. RESULTS: In neither the Dutch nor the Australian cohort was there a significant association between time to SNB and SN-positivity in either cohort, nor was there an impact of time to SNB on RFS or OS in either cohort. The spline-based HR curves for RFS and OS confirmed these findings. CONCLUSIONS: The time interval between diagnostic excision of a primary melanoma and SNB did not influence the SN-positivity rate or survival outcomes. This provides reassurance that neither early nor delayed definitive wide excision and SNB will adversely affect prognosis.
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Keywords: Excision, Melanoma, Sentinel node, Survival, Time, Oncology, Cancer Research, Journal Article
ISSN: 0959-8049
Publisher: Elsevier Limited
Note: Funding Information: SNL is supported by Melanoma Institute Australia. RAS and JFT are recipients of a NHMRC Program Grant (APP1093017) and RAS is supported by an NHMRC Practitioner Fellowship (APP1141295).The authors thank Rinus Voorham (at PALGA, the Dutch Pathology Registry) and Hazel Burke (at MIA) for their assistance with data extraction, and the team of the Netherlands Comprehensive Cancer Organisation (IKNL) for providing survival data from the Netherlands Cancer Registry. MAES was supported by a Research Fellowship Grant from the European Academy of Dermatology and Venereology (EADV). RAS and JFT are recipients of an Australian National Health and Medical Research Council (NHMRC) Program Grant, and RAS is supported by the NHMRC Practitioner Fellowship. This research was also supported by research project grants from Cancer Institute New South Wales and the NHMRC. SNL and RPMS are supported by Melanoma Institute Australia. The authors received valuable assistance from colleagues at their respective institutions, and support from the Cameron Family and the Ainsworth Foundation is also gratefully acknowledged. Funding Information: The authors thank Rinus Voorham (at PALGA, the Dutch Pathology Registry) and Hazel Burke (at MIA) for their assistance with data extraction, and the team of the Netherlands Comprehensive Cancer Organisation (IKNL) for providing survival data from the Netherlands Cancer Registry. MAES was supported by a Research Fellowship Grant from the European Academy of Dermatology and Venereology (EADV) . RAS and JFT are recipients of an Australian National Health and Medical Research Council (NHMRC) Program Grant, and RAS is supported by the NHMRC Practitioner Fellowship . This research was also supported by research project grants from Cancer Institute New South Wales and the NHMRC . SNL and RPMS are supported by Melanoma Institute Australia . The authors received valuable assistance from colleagues at their respective institutions, and support from the Cameron Family and the Ainsworth Foundation is also gratefully acknowledged. Publisher Copyright: © 2022 Elsevier Ltd
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