In-transit/local recurrences (IT/LR) in melanoma patients (pts) after sentinel node biopsy (SLNB) and therapeutic lymph node dissection (TLND) - one-center experience

Abstract

7502 Background: One of the major controversies related to SLNB is the suggestion of a higher incidence of IT/LR after completion lymph node dissection (CLND) performed for a positive node. This phenomenon is explained by lymphostasis. The aim the study was to analyze the incidence of IT/LR after SLNB, CLND and TLND done due to clinically detected node metastases and factors influencing IT/LR. Methods: Between 05/1995 and 05/2004 1187 consecutive pts underwent SLNB (median Breslow thickness - 2.5 mm) and 224 of them - subsequent CLND. During the same time period 306 pts underwent TLND (median Breslow - 3.9 mm). The margin of excision of primaries was >1cm in all cases. At a median follow-up time of 3 years we analyzed the incidence of IT/LR as the first relapse site and clinico-pathological parameters affecting these recurrences. Results: In SLN negative cases IT/LR were a rare site of the first recurrence (43/963; 4.5%); in SLN+/CLND IT/LR were detected in 34/224 cases - 15.2%. IT/LR in the SLNB group correlated (logistic regression) with SLN metastases (p < 0.0001), higher Breslow thickness (p = 0.0001) and lower extremity localization (p = 0.03). In the TLND group IT/LR were observed in 36/306 pts (11.8%), i.e. insignificantly less than in all CLND pts (p=0.25), but less common when analyzing only pts who relapsed (TLND: 36/190 - 19% vs. CLND: 34/104 - 33%; p = 0.008). Estimated 3-yr overall survival (from the date of relapse) in IT/LR only pts was better than in pts with the other types of relapses after lymphadenectomy (29% vs. 8%; log-rank test: p = 0.0001) (after CLND and TLND: 28% vs. 8% and 30% vs. 7%, respectively). Conclusions: IT/LR incidence in the entire group of SLN+/CLND pts is slightly higher than that observed in TLND melanoma pts, however it is a significantly more frequent type of relapse in CLND - considering only the pts with recurrences. It may imply a more favorable pattern of recurrence after SLNB. The most important factors affecting IT/LR incidence are: the presence of nodal metastases, Breslow thickness and localization on the lower extremity. No significant financial relationships to disclose.