Surgical outcomes of lymph node dissections for stage III melanoma after neoadjuvant systemic therapy are not inferior to upfront surgery
Menée à l'aide de données néerlandaises 2014-2018 portant sur 120 patients atteints d'un mélanome de stade III à haut risque de récidive et inclus dans un essai, cette étude analyse les résultats postopératoires d'un curage ganglionnaire précédé ou non d'une immunothérapie systémique
Background: Neoadjuvant systemic therapy has shown promising results in the treatment of high risk stage III melanoma, however the effects on surgery are currently unknown. This study aims to compare the surgical outcomes, in terms of postoperative complications, postoperative morbidity, duration of surgery and textbook outcomes, of patients with high risk stage III melanoma who received neoadjuvant systemic therapy followed by lymph node dissection with patients who received an upfront lymph node dissection. Methods: In this retrospective cohort study, patients with high risk stage III melanoma treated with neoadjuvant anti-PD1 and anti-CTLA4 in the OpACIN (NCT02437279) and OpACIN-neo (NCT02977052) trial between October 2014 and August 2018 were included and compared to patients who received upfront surgery in the same time period. Results: A total of 120 patients were included in this study, of whom 44 received neoadjuvant systemic therapy and 76 underwent upfront surgery. There was no significant difference in overall rate of postoperative complications between the neoadjuvant group and the upfront surgery group (31.8% vs. 36.8%, p=0.578) and neither in rate of postoperative morbidity (seroma 56.8% vs. 57.9%, p=0.908) (lymphedema 22.7% vs. 13.2%, p=0.175). There was a non-significant difference towards a slightly longer duration of surgery after neo-adjuvant immunotherapy (105 v. 90 minutes, p=0.077). There were no differences in textbook outcomes (50% vs. 49%, p=0.889). Conclusion: This study shows that the surgical outcomes for patients who underwent a lymph node dissection after neoadjuvant systemic immunotherapy or underwent upfront lymph node dissection for high risk stage III melanoma are comparable.