Critical appraisal:Rossi CR, Mozzillo N, Maurichi A, Pasquali S, Macripò G, Borgognoni L, et al 2014 3

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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

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 risk of bias rating

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: Please replace this text and briefly describe the reasons for your rating
Result of appraisal

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Completed by

Lyndal Alchin


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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:Lyndal.alchin
Topic area
Guidelines:Melanoma
Clinical question
Form
Form:Critical appraisal


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