Critical appraisal:Allan CP, Hayes AJ, Thomas JM 2008

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Critical Appraisal

Article being appraised

Allan CP, Hayes AJ, Thomas JM. Ilioinguinal lymph node dissection for palpable metastatic melanoma to the groin. ANZ J Surg 2008 Nov;78(11):982-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18959697.


Applicable clinical question

Key Facts

Study Design

case series

Study aims:

To review routine ilioinguinal dissection for all patients presenting with palpable metastatic melanoma in the groin.

Number of Patients:

72

Reported outcome(s):

Pelvic lymph node involvement
CT
Recurrence
Survival

Results of outcome(s):

Pelvic lymph node involvement in 22/72 (30.6%), as node status in the groin increased: higher likelihood of pelvic lymph node involvement (P = 0.07). Extranodal spread was seen in nearly one-quarter of patients and pelvic lymph node involvement had no influence on this figure (P = 1.0). 10/71 (14.1%) patients received adjuvant therapy.
Preoperative CT assessment of pelvic node involvement in 70/72 patients. Preoperative CT diagnosis both specificity and positive predictive value100%. CT scanning only diagnosing 12/20 patients histologically involved pelvic nodes (sensitivity 60%), 8 false-negative results (negative predictive value 86%), CT not reliable at excluding pelvic lymph node involvement.
Time to first recurrence: 8.7 months (0.8–69.7 months), majority being distant metastatic failure. Overall regional node relapse rate: (6/72, 8.3%). Distant metastatic failure: (31/72, 43.0%). Lymphoedema was reported in 31/72 (44.4%)
Univariate analysis of extranodal spread: significant adverse affect (hazard ratio (HR) 2.18 (95% confidence interval (CI) 1.14-4.17), P = 0.018). Regressed/unknown primary site, increasing disease-free interval and adjuvant therapy no benefit to disease-free survival. Increasing N stage in groin, trend towards a significant adverse affect (HR 1.40 (95% CI 0.94-1.99), P = 0.101). Involved pelvic nodes: reduced disease-free survival when compared to those who did not (29% vs 42%, HR 1.44 (95% CI 0.76–2.75)); not significant (P = 0.266). In all patients, 5-year disease-free survival was 38% (95% CI 26–50) and overall survival 47% (95% CI 33–60).

Includes an economic evaluation

no

Evidence ratings

Level of evidence

IV

Risk of bias
High risk of bias Comments: Patient selection not described other than date

Risk of bias assessment: case series

Subject selection:
Highly selected or not described (e.g. single-institution study)
Were the outcome measures blind to pre/post-intervention?
No, but objective measures used
Follow-up complete and all patients included in the analysis?
Yes (follow-up >95%)


Relevance of evidence
1 Additional comments: Please replace this text and briefly describe the reasons for your rating
Result of appraisal

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Completed by

Jackie Buck


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Article
Allan CP, Hayes AJ, Thomas JM. Ilioinguinal lymph node dissection for palpable metastatic melanoma to the groin. ANZ J Surg 2008 Nov;78(11):982-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18959697.
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