Critical appraisal:Rutkowski P, Nowecki ZI, Dziewirski W, Zdzienicki M, Pieñkowski A, Salamacha M, et al 2010

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Critical Appraisal

Article being appraised

Rutkowski P, Nowecki ZI, Dziewirski W, Zdzienicki M, Pieñkowski A, Salamacha M, et al. Melanoma without a detectable primary site with metastases to lymph nodes. Dermatol Surg 2010 Jun;36(6):868-76 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20482725.


Applicable clinical question

Key Facts

Study Design

cohort study

Study aims:

To compare outcomes of patients with clinical nodal melanoma metastases that occurred without a detectable primary tumor (melanoma of unknown primary site; MUP) with those with a known primary site (KPM).

Number of Patients:

459

Patients with Unknown Primary Melanoma Sites (n= 59)
Patients with Known Primary Melanoma Sites (n= 400)
Reported outcome(s):

Overall survival
Disease-free survival
Prognostic factors

Results of outcome(s):

OS and DFS (from the date of LND) were similar with MUP and KPM, MUP= slightly better prognoses, but not significance.
No statistical difference in OS, between MUP and stage III control group. 3-year and 5- year OS rates= 48.0% and 41.4%, respectively, for the MUP group (median 36.2 months) and 42.0% and 36.0%, respectively, for the KPM group (median 25.7 months). No significant differences between groups in the LND sites (inguinal and axillary basins). 5-year OS in MUP group (41.4%) similar to KPM (38.3%) localized on the extremities (p = .70) better than KPM localized on the trunk (27.9%; p = .02). Similar survival= analysis limited to patients large number of involved nodes (41 or 4 ;). For DFS, trend toward greater survival in MUP than KPM (p = .09) 3-year and 5-year DFS= 47.0% and 44.0%, for the MUP group (median 14.9 months) and 31.1% and 28.3%, for KPM group (median 11.7 months). Disease recurrences= less frequent MUP (31 patients; 52.5%) than KPM (299 cases; 74.8%; po.001), generally, disease pattern was similar to that observed in the first recurrences: 8 (26%) abdominal viscera, 6 (19%) subcutaneous tissue, 5 within the lymph nodes (16%; 2 in the same basin), 5 in the lung (16%), 4 in the brain (13%), 3 in the bones (10%). In pair-matched patients, trend observed toward a better prognosis in the MUP than KPM, failed to reach statistical significance. Prognostic factors, stage III melanoma (extracapsular extension of metastases, p = .002; number of metastatic nodes, p = .005) influenced OS in the MUP group. The only 2 independent factors influencing OS were extracapsular extension of metastases and number of metastatic nodes

Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-2

Risk of bias
High risk of bias Comments: Please replace this text and include any additional comments in regards to your quality rating

Risk of bias assessment: cohort study

Subject selection
"New technology" group
Highly selected or not described
Comparison group
Highly selected or not described
Comparability of groups on demographic characteristics and clinical features
Not comparable but adjusted analysis used
Measurement of outcomes
Outcome measures blind to technology used
No, but objective measures used
Same method of measurement used across comparison groups
Yes
Completeness of follow-up
Was follow-up complete and were all patients included in the analysis?
Yes (follow-up >95%) or survival analysis using all patients
Result of appraisal

Jutta's tick icon.png Included




Completed by

Jackie Buck


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Article
Rutkowski P, Nowecki ZI, Dziewirski W, Zdzienicki M, Pieñkowski A, Salamacha M, et al. Melanoma without a detectable primary site with metastases to lymph nodes. Dermatol Surg 2010 Jun;36(6):868-76 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20482725.
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