International Center-Level Variation in Utilization of Completion Lymph Node Dissection and Adjuvant Systemic Therapy for Sentinel Lymph Node-Positive Melanoma at Major Referral Centers

• Type of Material: Article
• Authors: Kristy K Broman, University of Alabama at Birmingham; Tasha M Hughes, University of Michigan; Brooke C Bredbeck, University of Michigan; James Sun, Moffitt Cancer Center, Tampa; Dennis Kirichenko, University of South Florida Morsani; Michael J Carr, Moffitt Cancer Center, Tampa; Avinash Sharma, Memorial Sloan Kettering Cancer Center; Edmund K Bartlett, Memorial Sloan Kettering Cancer Center; Amanda A. G Nijhuis, University of Sydney; John F Thompson, University of Sydney; Tina J Hieken, Mayo Clinic; Lisa Kottschade, Mayo Clinic; Jennifer Downs, Peter MacCallum Cancer Center, Melbourne; David E Gyorki, Peter MacCallum Cancer Center, Melbourne; Emma Stahlie, Netherlands Cancer Institute; Alexander van Akkooi, Netherlands Cancer Institute; David W Ollila, University of North Carolina; Kristin O'shea, University of North Carolina; Yun Song, University of Pennsylvania; Giorgos Karakousis, University of Pennsylvania; Marc Moncrieff, Norwich University; Jenny Nobes, Norwich University; John Vetto, Oregon Health & Science University; Dale Han, Oregon Health & Science University; Meghan Hotz, Fox Chase Cancer Center, Philadelphia; Jeffrey M Farma, Fox Chase Cancer Center, Philadelphia; Jeremiah L Deneve, University of Tennessee; Martin D Fleming, University of Tennessee; Matthew Perez, Emory University; Kirsten Baecher, Emory University; Michael Lowe, Emory University; Roger Olofsson Bagge, University of Gothenburg; Jan Mattsson, University of Gothenburg; Ann Y Lee, NYU Langone Health, New York; Russell S Berman, NYU Langone Health, New York; Harvey Chai, University of Adelaide; Hidde M Kroon, University of Adelaide; Juri Teras, North Estonia Medical Centre Foundation, Tallinn; Roland M Teras, North Estonia Medical Centre Foundation, Tallinn; Norma E Farrow, Duke University; Georgia M Beasley, Duke University; Jane Yuet Ching Hui, University of Minnesota; Lukas Been, University Medical Center, Groningen; Schelto Kruijff, H Lee Moffitt Canc Ctr & Res Inst; Brandy Sinco, University of Michigan; Amod A Sarnaik, University of South Florida Morsani; Vernon K Sondak, University of South Florida Morsani; Jonathan S Zager, University of South Florida Morsani; Lesly A Dossett, University of Michigan
• Language: English
• Date: 2023-05-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/SLA.0000000000005370
• Title of Journal or Parent Work: ANNALS OF SURGERY
• Volume: 277
• Issue: 5
• Start Page: E1106
• End Page: E1115
• Grant/Funding Information: Dr. Zager has received research funding from Novartis, Philogen, Delcath Systems, Amgen, Provectus, Novartis and Castle Biosciences.; Dr. Sarnaik is a consultant to Iovance Biotherapeutics, Guidepoint, Defined Health, and Gerson Lehman group. His institution has received research funding from Iovance Biotherapeutics and Provectus Inc.; Dr. Hieken has received research funding from Genentech and the Breast Cancer Research Foundation.; Ms. Kottschade was received research funding from Bristol-Meyers Squibb and serves on the advisory board for Novartis.
• Keywords: PERFORMANCE; IPILIMUMAB; SURVIVAL; Life Sciences & Biomedicine; Science & Technology; BIOPSY; STAGE-III MELANOMA; sentinel lymph node; active surveillance; PREDICTION; melanoma; de-implementation; implementation science; adjuvant therapy; MULTICENTER; Surgery; completion lymph node dissection
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Engineering, Biomedical; Health Sciences, Oncology

Abstract

Objective: The aim of this study was to determine overall trends and center-level variation in utilization of completion lymph node dissection (CLND) and adjuvant systemic therapy for sentinel lymph node (SLN)-positive melanoma. Summary Background Data: Based on recent clinical trials, management options for SLN-positive melanoma now include effective adjuvant systemic therapy and nodal observation instead of CLND. It is unknown how these findings have shaped practice or how these contemporaneous developments have influenced their respective utilization. Methods: We performed an international cohort study at 21 melanoma referral centers in Australia, Europe, and the United States that treated adults with SLN-positive melanoma and negative distant staging from July 2017 to June 2019. We used generalized linear and multinomial logistic regression models with random intercepts for each center to assess center-level variation in CLND and adjuvant systemic treatment, adjusting for patient and disease-specific characteristics. Results: Among 1109 patients, performance of CLND decreased from 28% to 8% and adjuvant systemic therapy use increased from 29 to 60%. For both CLND and adjuvant systemic treatment, the most influential factors were nodal tumor size, stage, and location of treating center. There was notable variation among treating centers in management of stage IIIA patients and use of CLND with adjuvant systemic therapy versus nodal observation alone for similar risk patients. Conclusions: There has been an overall decline in CLND and simultaneous adoption of adjuvant systemic therapy for patients with SLN-positive melanoma though wide variation in practice remains. Accounting for differences in patient mix, location of care contributed significantly to the observed variation.