Critical appraisal:Rossi CR, Mozzillo N, Maurichi A, Pasquali S, Macripò G, Borgognoni L, et al 2014
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.
- What is the appropriate treatment for macroscopic (i.e. detectable clinically or by ultrasound) nodal metastasis?
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
indicators for lymphadenectomy
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.
|High risk of bias||Comments: Please replace this text and include any additional comments in regards to your quality rating|
Risk of bias assessment: case series
- Selected group (e.g. multi-institution study)
- No, but objective measures used
- No or not described
|2||Additional comments: prognostic indicators for lymphadenectomy|
- 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.
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- Clinical question
Section below only relevant for Cancer Council Project Officer