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Background <p>The clinical utility of immediate complete lymph node dissection (CLND) following positive sentinel node (SN) remains controversial in acral melanoma (AM), in Asian populations where AM is more prevalent. This study aimed to compare the survival outcomes of immediate CLND versus observation (OBS) in Japanese patients with stage III sole AM and positive SN.</p> Methods <p>This retrospective, multicenter study included 154 patients (CLND: 90, OBS: 64) with stage III sole AM with positive SN, across 44 Japanese institutions. Recurrence-free survival (RFS), distant metastasis-free survival (DMFS), regional metastasis-free survival (RMFS), and overall survival (OS) were compared between the two groups. Cox multivariable analysis and propensity score matching (PSM) were performed to adjust for potential confounders.</p> Results <p>With a median follow-up of 3.9&#xa0;years, non-significant differences were observed in RFS, DMFS, RMFS, or OS between the CLND and OBS groups (<i>P</i> = 0.33, 0.32, 0.08, and 0.21, respectively). Cox multivariable analysis identified N3a nodal stage as an independent negative factor for OS (HR: 2.6, <i>P</i> = 0.02), whereas CLND and other variables were not associated. After PSM, 92 (46 each) were matched. RFS and DMFS remained comparable (<i>P</i> = 0.16 and 0.19), with a non-significant trend toward improved RMFS in the CLND group (<i>P</i> = 0.08), and no difference in OS (<i>P</i> = 0.14).</p> Conclusions <p>Immediate CLND did not provide a survival advantage over OBS in patients with stage III sole AM and positive SN. These findings do not support the routine use of CLND in this population.</p> <p><i>Trial registration</i> Not applicable.</p>

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Prognostic outcomes of immediate complete lymph node dissection versus observation in patients with acral melanoma of the sole with sentinel node metastasis: a retrospective, multicenter study

  • 期刊论文

  • 发表日期：

    2025年12月5日

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  • Sadao Inoue,
  • Shigeru Koizumi,
  • Naoya Yamazaki,
  • Yuki Ichigozaki,
  • Hiroshi Kitagawa,
  • Yukiko Kiniwa,
  • Sayuri Sato,
  • Toshihiro Takai,
  • Reiichi Doi,
  • Takamichi Ito,
  • Masahito Yasuda,
  • Yutaka Kuwatsuka,
  • Takeo Maekawa,
  • Jun Asai,
  • Takuya Miyagawa,
  • Shigeto Matsushita,
  • Takeru Funakoshi,
  • Yosuke Yamamoto,
  • Takashi Inozume,
  • Akiko Kishi,
  • Tatsuya Takenouchi,
  • Hiraku Kokubu,
  • Shusaku Ito,
  • Yoshiyasu Umeda,
  • Yuki Yamamoto,
  • Shoichiro Ishizuki,
  • Shiro Iino,
  • Hiroshi Uchi,
  • Tomoe Nakagawa,
  • Kazuhiro Inafuku,
  • Takahiro Haga,
  • Takahide Kaneko,
  • Masahiro Nakagawa,
  • Hideki Kamiya,
  • Masaru Arima,
  • Toshihiko Hoashi,
  • Azusa Hiura,
  • Nobuo Kanazawa,
  • Keiko Manabe,
  • Masashi Ishikawa,
  • Kenji Asagoe,
  • Utsugi Iwasawa,
  • Takafumi Kadono,
  • Naohito Hatta,
  • Shoichiro Minami,
  • Eiji Nakano,
  • Dai Ogata,
  • Satoshi Fukushima,
  • Hisashi Uhara,
  • Kenta Nakama,
  • Takaya Komori,
  • Ken Igawa,
  • Yasuhiro Nakamura

摘要

Background

The clinical utility of immediate complete lymph node dissection (CLND) following positive sentinel node (SN) remains controversial in acral melanoma (AM), in Asian populations where AM is more prevalent. This study aimed to compare the survival outcomes of immediate CLND versus observation (OBS) in Japanese patients with stage III sole AM and positive SN.

Methods

This retrospective, multicenter study included 154 patients (CLND: 90, OBS: 64) with stage III sole AM with positive SN, across 44 Japanese institutions. Recurrence-free survival (RFS), distant metastasis-free survival (DMFS), regional metastasis-free survival (RMFS), and overall survival (OS) were compared between the two groups. Cox multivariable analysis and propensity score matching (PSM) were performed to adjust for potential confounders.

Results

With a median follow-up of 3.9 years, non-significant differences were observed in RFS, DMFS, RMFS, or OS between the CLND and OBS groups (P = 0.33, 0.32, 0.08, and 0.21, respectively). Cox multivariable analysis identified N3a nodal stage as an independent negative factor for OS (HR: 2.6, P = 0.02), whereas CLND and other variables were not associated. After PSM, 92 (46 each) were matched. RFS and DMFS remained comparable (P = 0.16 and 0.19), with a non-significant trend toward improved RMFS in the CLND group (P = 0.08), and no difference in OS (P = 0.14).

Conclusions

Immediate CLND did not provide a survival advantage over OBS in patients with stage III sole AM and positive SN. These findings do not support the routine use of CLND in this population.

Trial registration Not applicable.