{"doi":"10.1016/j.jamcollsurg.2020.11.014","title":"Surveillance of Sentinel Node-Positive Melanoma Patients with Reasons for Exclusion from MSLT-II: Multi-Institutional Propensity Score Matched Analysis","abstract":"<jats:sec>\n            <jats:title>BACKGROUND:</jats:title>\n            <jats:p>In sentinel lymph node (SLN)-positive melanoma, two randomized trials demonstrated equivalent melanoma-specific survival with nodal surveillance vs completion lymph node dissection (CLND). Patients with microsatellites, extranodal extension (ENE) in the SLN, or &gt;3 positive SLNs constitute a high-risk group largely excluded from the randomized trials, for whom appropriate management remains unknown.</jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>STUDY DESIGN:</jats:title>\n            <jats:p>SLN-positive patients with any of the three high-risk features were identified from an international cohort. CLND patients were matched 1:1 with surveillance patients using propensity scores. Risk of any-site recurrence, SLN-basin–only recurrence, and melanoma-specific mortality were compared.</jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:</jats:title>\n            <jats:p>Among 1,154 SLN-positive patients, 166 had ENE, microsatellites, and/or &gt;3 positive SLN. At 18.5 months median follow-up, 49% had recurrence (vs 26% in patients without high-risk features, p &lt; 0.01). Among high-risk patients, 52 (31%) underwent CLND and 114 (69%) received surveillance. Fifty-one CLND patients were matched to 51 surveillance patients. The matched cohort was balanced on tumor, nodal, and adjuvant treatment factors. There were no significant differences in any-site recurrence (CLND 49%, surveillance 45%, p = 0.99), SLN-basin–only recurrence (CLND 6%, surveillance 14%, p = 0.20), or melanoma-specific mortality (CLND 14%, surveillance 12%, p = 0.86).</jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:</jats:title>\n            <jats:p>SLN-positive patients with microsatellites, ENE, or &gt;3 positive SLN constitute a high-risk group with a 2-fold greater recurrence risk. For those managed with nodal surveillance, SLN-basin recurrences were more frequent, but all-site recurrence and melanoma-specific mortality were comparable to patients treated with CLND. Most recurrences were outside the SLN-basin, supporting use of nodal surveillance for SLN-positive patients with microsatellites, ENE, and/or &gt;3 positive SLN.</jats:p>\n          </jats:sec>","journal":"Journal of the American College of Surgeons","year":2021,"id":655057,"datarank":0.48283137373023016,"base_score":3.2188758248682006,"endowment":3.2188758248682006,"self_citation_contribution":0.48283137373023016,"citation_network_contribution":0.0,"self_endowment_contribution":0.48283137373023016,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":24,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":640755,"name":"Tasha M. 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