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Management of acral melanoma with lymph node macrometastasis in the post-MSLT-II era: focus on the effect and timing
Chengcai Liang1,2, Huajie Guan1,2, Xunyi Long1,2
1State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
Background:
Limited studies have exclusively investigated the role of completion lymph node dissection (CLND) in acral melanoma (AM) with lymph node macrometastasis (macroLNM). This multicenter study aimed to evaluate the impact of CLND and its performance timing on AM patients with macroLNM.
Patients And Methods:
The study enrolled 384 non-metastatic AM patients with initial or recurrent macroLNM from 4 tertiary hospitals. These patients were categorized into 3 groups based on the type of CLND: No CLND, CLND, or therapeutic lymph node dissection (TLND). The CLND group was further divided into early and late groups according to the timing of CLND. Kaplan-Meier and Cox multivariable analyses were performed to assess survival differences.
Results:
Of the total cohort, both the 5-year overall survival (OS) and recurrence-free survival (RFS) in the No CLND group were significantly worse than those in the CLND and TLND groups (P = .009 and P = .021, respectively). Multivariate analysis demonstrated that CLND performance remained to be significantly associated with both OS and RFS (all P < .05). Among the CLND group, CLND timing independently predicted worse RFS (P = .049) but not OS at multivariate analysis. Notably, the late CLND group tended to significantly have more large-size metastatic nodes. Pearson correlation analysis revealed a significant correlation between preoperative time interval and the enlargement in size of lymph node metastasis (r = 0.356, P = .002).
Conclusions:
CLND remains crucial for improving prognosis for AM with macroLNM. Furthermore, delayed CLND might lead to larger metastatic lymph nodes and decreased RFS. Thus, performing CLND earlier may be beneficial for this patient population.
