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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2009

01-10-2009 | Melanomas

In Reply: Cost-Effectiveness of Sentinel Node Biopsy for Melanoma

Authors: John F. Thompson, MD, Rachael L. Morton, MScMed (Clin Epi) (Hons)

Published in: Annals of Surgical Oncology | Issue 10/2009

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Excerpt

Dr. Thomas suggests that the calculations made in our evaluation of the cost-effectiveness of sentinel node biopsy (SNB) depend entirely on the accuracy of the 20% survival difference reported in the third interim analysis of MSLT-I.1 This claim is not correct. The survival difference in life-years was not derived from a comparison of the two subgroups of node-positive patients but from comparison of the two randomized cohorts, i.e., from the total trial population (Fig. A, p. 932).1 Furthermore, the results of the economic evaluation were driven by three other factors: (1) higher disease-free survival at 5 years in the entire group of patients who had a sentinel node biopsy (SNB); (2) the lower complication rate (and resulting better quality of life) in the node-positive patients who had an immediate complete lymph node dissection (CLND) compared with those who later developed palpable nodal recurrence and had a delayed CLND; and (3) lower costs associated with an immediate CLND. …
Literature
1.
Morton RL, Howard K, Thompson JF. The cost-effectiveness of sentinel node biopsy in patients with intermediate thickness primary cutaneous melanoma. Ann Surg Oncol. 2009;16:929–40.CrossRefPubMed
2.
Thomas JM. Prognostic false-positivity of the sentinel node in melanoma. Nat Clin Pract Oncol. 2008;5:18–23.CrossRefPubMed
3.
Morton DL, Cochran AJ, Thompson JF. The rationale for sentinel-node biopsy in primary melanoma. Nat Clin Pract Oncol. 2008;5:510–1.CrossRefPubMed
4.
van Akkooi AC, de Wilt JH, Verhoef C, et al. Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative? Ann Oncol. 2006;17:1578–85.CrossRefPubMed
5.
Ollila DW, Ashburn JH, Amos KD, et al. Metastatic melanoma cells in the sentinel node cannot be ignored. J Am Coll Surg. 2009;208:924–9.CrossRefPubMed
6.
Scolyer RA, Murali R, Satzger I, Thompson JF. The detection and significance of melanoma micrometastases in sentinel nodes. Surg Oncol. 2008;17:165–74.CrossRefPubMed
Metadata
Title
In Reply: Cost-Effectiveness of Sentinel Node Biopsy for Melanoma
Authors
John F. Thompson, MD
Rachael L. Morton, MScMed (Clin Epi) (Hons)
Publication date
01-10-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 10/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0589-z

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