Improvement and persistent disparities in completion lymph node dissection: Lessons from the National Cancer Database
Brian S Chu1, Wima Koffi2, Richard S Hoehn2
1University of Cincinnati College of Medicine, Cincinnati, Ohio.
Journal of Surgical Oncology
|July 26, 2017
Summary
Completion lymph node dissection (CLND) rates remain low for melanoma patients with positive sentinel lymph node biopsies (SLNB), with persistent racial and socioeconomic disparities. Improving CLND adherence is crucial pending further research.
Area of Science:
- Oncology
- Surgical Oncology
- Health Services Research
Background:
- Completion lymph node dissection (CLND) is a recommended procedure for melanoma patients with positive sentinel lymph node biopsies (SLNB).
- However, approximately 50% of eligible patients do not undergo this procedure.
- Understanding trends and factors influencing CLND utilization is critical.
Purpose of the Study:
- To determine temporal trends in CLND performance among melanoma patients.
- To identify demographic, socioeconomic, and clinical factors associated with CLND variability.
- To highlight persistent disparities in CLND utilization.
Main Methods:
- Utilized the National Cancer Database (NCDB) to identify patients undergoing wide local excision (WLE) with or without SLNB and CLND.
- Created cohorts based on demographic/socioeconomic variables and treatment eras (2003-2007 and 2008-2012).
- Performed univariate and multivariate analyses to assess factors associated with CLND performance and trends.
Main Results:
- Out of 122,849 patients undergoing WLE with SLNB, 24,267 (19.8%) had positive SLNBs, and 13,594 (56.0%) proceeded to CLND.
- Lower CLND rates were associated with Medicaid/Medicare insurance in Era 1, uninsured status in Era 2, Black race, and head/neck or lower extremity lesions in both eras.
- Black patients demonstrated the largest increase in CLND usage (+9.2%) over the study period.
Conclusions:
- CLND utilization remains suboptimal, with ongoing racial and socioeconomic disparities.
- Factors such as insurance status, race, and lesion location significantly influence CLND adherence.
- Further research and focused interventions are necessary to improve CLND rates and address existing disparities, especially while awaiting results from trials like MSLT-2.
