Prognostic value of sentinel lymph node biopsy compared with that of Breslow thickness: implications for informed consent in patients with invasive melanoma.

BACKGROUND

Sentinel lymph node (SLN) status is reportedly a powerful prognosticator of survival. Breslow thickness alone provides significant prognostic information.

OBJECTIVE

To assess overall survival (OS) according to tumor depth based on SLN status.

MATERIALS AND METHODS

MEDLINE, EMBASE, and the Cochrane Central Database were searched for studies. Included studies evaluated overall survival according to SLNB results and were stratified according to Breslow thickness. Meta-analysis was performed if appropriate in each category for which three or more studies reported risk estimates and variability measurement.

RESULTS

Twenty-nine articles met inclusion criteria. Six met the criteria for meta-analysis. In individuals with thin melanoma (<1 mm), SLN-negative status conferred no survival advantage (sign test, p > .99). Few studies were available for intermediate depths, and most reported worse survival in SLN-positive patients, although the difference was not statistically significant (p > .05). For thick melanoma (>4 mm), SLN positivity was related to worse prognosis (sign test, p = .004). Based on the pooled results of six studies of patients with tumors 4 mm thick or thicker, SLN-positive patients had a greater likelihood of dying (hazard ratio = 2.42, 95% confidence interval = 2.00-2.92).

CONCLUSIONS

Sentinel lymph node biopsy may not provide more-accurate prognostic information than Breslow thickness for most melanomas.