Critical appraisal:Rossi CR, Mozzillo N, Maurichi A, Pasquali S, Macripò G, Borgognoni L, et al 2014

Critical Appraisal

Article being appraised

Rossi CR, Mozzillo N, Maurichi A, Pasquali S, Macripò G, Borgognoni L, et al. Number of excised lymph nodes as a quality assurance measure for lymphadenectomy in melanoma. JAMA Surg 2014 Jul;149(7):700-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24804856.

Applicable clinical question

What is the appropriate treatment for macroscopic (i.e. detectable clinically or by ultrasound) nodal metastasis?

Key Facts

Study Design

case series

Study aims:

To investigate the distribution of the number of excised LNs in a large patient series to identify values that may serve as benchmark for monitoring the quality of lmyphadenectomy in patients with melanoma

Number of Patients:

2526

median (IQR) number of excised LNs was 20 (15-27), 21 (14-33), 29 (21-41), 11 (9-14), and 21 (16-26), respectively. Ninety percent of the patients had 12, 7, 14, 6, and 13 excised LNs (10th percentile of the distribution) after 3-level axillary, 3-level or less neck, 4-level or more neck, inguinal, and ilioinguinal dissection, respectively.

Reported outcome(s):

indicators for lymphadenectomy

Results of outcome(s):

Univariate analysis, associations between number of excised LNs and more recent year of diagnosis (P<.001), higher-volume centers (P<.001), younger age (P<.001), male sex (P<.001), micrometastasis (P=.005), and more positive LNs (P<.001) were statistically significant, although the differences between the median values were small. Primary tumor features were not associated with the number of excised LNs.
Multivariable analysis, more recent year of diagnosis (correlation coefficient, 1.96; 95%CI, 1.01 to 2.90;P<.0001), high-volume institution (1.75; 0.95 to 2.55; P < .001), male sex (1.61; 95%CI, 1.13 to 2.76; P < .001), micrometastasis (1.95; 95% CI, 1.13 to 2.76; P < .001), and more positive LNs (0.46; 95%CI, 0.36 to 0.56; P < .001) were associated independently with a greater number of excised LNs. Age 54 years or older was associated with fewer excised LNs (−1.54; −2.26 to −0.82; P<.001).
Treatment in high volume institutions= 3 more excised LNs (median values) than low volume institution. Statistical significance for axillary dissections (low-volume:median [IQR], 19[15-25]; high- volume: 21 [16-27]; P=.009), no longer significant when a 3-level or less and 4-level or more neck (P=.54), inguinal (P=.37), and ilioinguinal (P=.74) dissection was performed.

Includes an economic evaluation

no

Evidence ratings

Level of evidence

IV

Risk of bias

High risk of bias

Comments: Please replace this text and include any additional comments in regards to your quality rating

Show/Hide Risk of bias assessment

Risk of bias assessment: case series

Subject selection:

Selected group (e.g. multi-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?

No or not described

Relevance of evidence

2	Additional comments: prognostic indicators for lymphadenectomy

Result of appraisal

Included

Completed by

Lyndal Alchin

This appraisal has been completed.

Article: Rossi CR, Mozzillo N, Maurichi A, Pasquali S, Macripò G, Borgognoni L, et al. Number of excised lymph nodes as a quality assurance measure for lymphadenectomy in melanoma. JAMA Surg 2014 Jul;149(7):700-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24804856.

Assigned to

User:Jackie.buck

Topic area

Guidelines:Property "Appraisal topic" (as page type) with input value "Guidelines:" contains invalid characters or is incomplete and therefore can cause unexpected results during a query or annotation process.

Clinical question

What is the appropriate treatment for macroscopic (i.e. detectable clinically or by ultrasound) nodal metastasis?

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