Prognostic factors and population-based analysis of melanoma with sentinel lymph node biopsy

Ping-Chung Wu,Yu-Ching Chen,Lee-Wei Chen,Hsiu-Min Chen

doi:10.1038/s41598-021-99950-1

Abstract

Cutaneous malignant melanoma is a rare but fatal disease in East Asia. Despite its increasing incidence, a general lack of awareness about the disease was noted. This study aims to provide population-based prognostic analysis of melanoma with sentinel lymph node biopsy (SLNB) in Taiwan. We conducted this retrospective cohort study using the data from Taiwan National Health Insurance Research Database during 1997–2013. The study cohort contains 3284 patients. The 5-year survival rates of patients undergoing SLNB and not undergoing SLNB were 45.5% and 33.6%. In multivariate analysis, age ≥ 80 years [adjusted hazard ratio (aHR) = 2.15] and male (aHR = 1.19) were associated with a poorer prognosis, while high social economic status (SES) (aHR = 0.69) and undergoing SLNB (aHR = 0.84) were good prognostic factors. Old age and low SES were associated with lower percentages of patients undergoing SLNB (P < 0.001). E-value analysis suggested robustness to unmeasured confounding. In conclusion, undergoing SLNB was associated with a better prognosis. The poor prognosis of old age and low SES may be due to decreased percentages of patients undergoing SLNB. Therefore, we recommend that SLNB should be performed on patients, especially in old age or low SES, who are candidates for SLNB according to current guidelines to achieve maximal survival.

Highlights

Cutaneous malignant melanoma is a rare but fatal disease in East Asia
The National Health Insurance (NHI) Research Database (NHIRD), derived from the payment system of the NHI Administration (NHIA) and managed by the National Health Research Institute (NHRI), possesses abundant information regarding most kinds of medical services, such as outpatient visits, inpatient records, and medical illness diagnosis codes according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding system
One reason that old age may be associated with a poor prognosis is that melanomas in older patients were more frequently late d iagnosed[26], which may be related to less attention to changes on their skin, low awareness of the early signs and symptoms of melanoma, increase of seborrheic keratoses or development of a higher proportion of melanomas in hard-to-see anatomical sites[28]