The Stage III Melanoma in Cervical Region, Prognostic Impact of The Lymph Node Ratio of The Neck Dissections

Author(s): Quiriny M, Shall F, Moreau M, Willemse E, Sales F, Andry G, Digonnet A

Purpose

The lymph node (LN) status is one of the most important prognostic factors of melanoma. The first treatment of LN metastasis is the lymph node dissection (LND). To date the surgical technic for neck metastasis is discussed. The lymph node ratio (LNR) is defined as the number of invaded LNs dividing by the total number of removed LNs. The aim of our study was to evaluate the impact of the LNR and the extent of neck LND on the prognosis.

Methods

We recorded LNDs for neck LN metastasis during 16 years. Selective LND (SLND) was limited to the level with LN metastasis. Extensive LND (ELND) was extended to the adjacent LN level. The LNRs were categorized using cutoff points. Among the 62 included patients, 48 LNRs were available for the survival analysis. Time to event endpoint were defined as the time between the event and the date of the previous recurrence. The cut-off p-value for significant statistic was 0.05.

Results

Breslow thickness < 2mm presented a longer OS (p=0.035) and extracapsular spread presented a shorter OS (p=0.035). Clark levels III and IV presented a longer systemic disease free survival. The OS and the regional control were longer when the LNRs were respectively < 5% and < 10%. ELND improved the regional control, compared to SLND (p=0.02).

Conclusion

The ELND could improve the regional control compared to SLND. The LNR of neck LNDs could be a prognostic factor and should be low as possible to improve the outcomes.