Sentinel node biopsy and survival in cutaneous melanoma: a nationwide population-based cohort study
Menée à l'aide de données danoises portant sur 6 952 patients atteints d'un mélanome, cette étude analyse l'effet d'une biopsie du ganglion sentinelle sur la survie
Introduction: The therapeutic benefit of sentinel node biopsy (SNB) for melanoma patients remains controversial. We aimed to evaluate the association between SNB and survival outcomes in a nationwide population-based Danish cohort.
Materials and Methods: This retrospective cohort study included patients diagnosed with cutaneous melanoma between 2010 and 2017 who were candidates for SNB according to contemporary national guidelines. Augmented inverse probability of treatment weighting (AIPTW) was used to estimate standardized absolute risks and risk differences (RD) for 5-year overall survival, melanoma-specific mortality, other-cause mortality, and recurrence outcomes under two hypothetical strategies: all patients undergoing SNB versus no patients undergoing SNB.
Results: Of 6,952 eligible patients, 5,679 (81.7%) underwent SNB. After AIPTW, the standardized 5-year overall survival was higher under the SNB strategy (82.5% vs 73.7%, RD -8.8 pp, 95% CI -12.0; -5.6), whereas there was no clear difference in melanoma-specific mortality between strategies (9.0% vs 9.8%, RD -0.8 pp, 95% CI -3.0; 1.5). Other-cause mortality was lower under the SNB strategy (8.5% vs 16.8%, RD -8.3 pp, 95% CI -11.1; -5.5). No difference was found for standardized 5-year risk of any recurrence (19.0% vs 18.9%; RD 0.1 pp, 95% CI -3.2; 3.4), nor for distant recurrence. Regional nodal recurrence was lower under the SNB strategy (4.6% vs 8.5%, RD -3.9 pp, 95% CI -6.3; -1.5).
Conclusion: Since SNB cannot plausibly influence other-cause mortality, our findings indicate residual confounding despite robust adjusted analyses. Observational data such as ours cannot reliably determine whether SNB confers a therapeutic effect.
European Journal of Surgical Oncology , article en libre accès, 2026