SLN status optimizes adjuvant therapy decision-making in clinical stage IIB/C melanoma

The performance of a prognostic model with sentinel lymph node (SLN) biopsy status in assessing patient risk for 5-year melanoma-specific death is superior to that of a model with primary tumour staging factors alone for threshold mortality rates ≥30 percent, a study has shown.

To determine the usefulness of SLN status in guiding the recommendations for adjuvant therapy, the authors conducted a retrospective study in patients with clinical stage IIB/C cutaneous melanoma. Eligible patients underwent wide local excision and SLN biopsy between 2004 and 2011, and were identified from the Surveillance, Epidemiology, and End Results database.

The authors developed two prognostic models, with and without SLN status, to predict the risk of melanoma-specific death. Net benefit at treatment thresholds of 20 percent to 40 percent risk of 5-year melanoma-specific death was the primary outcome.

A total of 4,391 patients were included in the analysis, and their 5-year melanoma-specific death rate stood at 46 percent.

The prognostic model that included SLN status achieved greater net benefit at treatment thresholds from 30 percent to 78 percent compared to the model that did not include SLN status. Such added net benefit for the model with SLN status was sustained in subgroup analysis of patients in different age groups and with various T stages.

“A prognostic model with SLN status estimating patient risk for 5-year melanoma-specific death provides superior net benefit compared to a model with primary tumour staging factors alone for threshold mortality rates ≥30 percent,” the authors said.

Notably, this study was limited by its retrospective design,” they pointed out.