Age-related disparities in use of completion lymphadenectomy for melanoma sentinel lymph node metastasis

• Published in: The Journal of surgical research 2013-11, Vol.185 (1), p.240-244
• Main Authors: Shah, Dhruvil R., MD, Yang, Anthony D., MD, Maverakis, Emanual, MD, Martinez, Steve R., MD, MAS
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Age Distribution; Aged; Aged, 80 and over; Child; Child, Preschool; Completion lymphadenectomy; Disparities; Female; Humans; Infant; Lymph Node Excision - utilization; Lymphatic Metastasis - pathology; Male; Melanoma; Melanoma - epidemiology; Melanoma - secondary; Melanoma - surgery; Middle Aged; Randomized Controlled Trials as Topic; SEER Program - statistics & numerical data; Sentinel lymph node; Sentinel Lymph Node Biopsy - utilization; Skin Neoplasms - epidemiology; Skin Neoplasms - pathology; Skin Neoplasms - surgery; Surgery; Young Adult
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2013.05.090

Abstract Background Guidelines recommend that patients with melanoma metastatic to the sentinel lymph node (SLN) undergo a completion lymphadenectomy (CLND) of the affected lymph node basin. We have previously reported on decreased use of SLN biopsy among elderly patients. We hypothesized that elderly patients with SLN metastases would have lower rates of CLND relative to their younger counterparts. Methods The Surveillance, Epidemiology, and End Results database was queried for patients who underwent SLN biopsy for intermediate thickness cutaneous melanoma (Breslow thickness 1.01 mm–4.00 mm) from 2004 to 2008 and were found to have SLN metastasis. Patients were categorized according to age by decade. We then used multivariate logistic regression models to predict receipt of CLND. Additional covariates included sex, race/ethnicity, T stage, tumor histology, tumor location, and ulceration. The likelihood of receiving a CLND was reported as OR with 95% CI; significance was set at P  ≤ 0.05. Results Entry criteria were met by 765 patients. Of these, 548 (71.6%) patients underwent CLND. On multivariate analysis, patients in the age groups 70–79 y old (OR 0.39, CI 0.20–0.78; P = 0.007) and ≥80 y old (OR 0.27, CI 0.12–0.61; P = 0.001) were less likely to undergo CLND than the youngest age group (1–39 y old). Conclusions Elderly patients with SLN metastasis are less likely to receive CLND than their younger counterparts. A multi-center randomized clinical trial evaluating the potential survival benefit of CLND is ongoing. Further research to assess reasons why the elderly are less likely to receive CLND are needed.