Evidence based medicine

(prognosis)
Prognosis in patients with sentinel
node-positive melanoma without
immediate completion lymph node
dissection
Nama: Reza Rahmana Putra
NPM: 1102010239

Skenario
Laki-laki 55 tahun datang dengan keluhan tahi
lalatnya yang terus berkembang pada leher.
Serta terdapat rasa nyeri dan terbakar pada
tahi lalat dan keluhan berat badan yang terus
turun selama satu tahun terakhir. Dokter
mendiagnosa pasien menderita Melanoma
Maligna dengan metastasis ke kelenjar getah
bening. Dokter menyarankan untuk
melakukan diseksi terhadap kelenjar getah
bening.Pasien ingin tahu bagaimana prognosis
setelah dilakukan CLND.

Foreground Question
Bagaimana prognosis pasien melanoma maligna dengan metastasis
kelenjar getah bening setelah dilakukan CLND ?

PICO

Patient
: Laki laki 55 tahun
Intervention : CLND
Comparison: Outcome : Pasien yang mendapatkan
terapi
CLND memiliki prognosis
yang
buruk karena dapat terjadi
mikrometastasis

 KATA KUNCI
Melanoma AND Prognosis AND Surgery
PEMILIHAN SITUS
http://web.a.ebscohost.com/ehost/
pdfviewer/pdfviewer?
sid=f01af2fe-1eef-4828-8e1ef892cc5b8bb5@sessionmgr4005&v
id=2&hid=4109
HASIL PENCARIAN
54 artikel

Review jurnal
Background: The therapeutic value of immediate completion lymph node dissection (CLND) for
sentinel node (SN)-positive melanoma is unknown. The aim of this study was to evaluate the impact of
immediate CLND on the outcome of patients with SN-positive melanoma.
Methods: Patients with SN metastases treated between 1993 and 2008 at ten cancer centres from the
European Organization for Research and Treatment of Cancer Melanoma Group were included in this
retrospective study. Maximum tumour size, intranodal location and penetrative depth of SN metastases
were measured. Outcome in those who had CLND was compared with that in patients who did not
undergo completion lymphadenectomy.
Results: Of 1174 patients with SN-positive melanoma, 1113 (948 per cent) underwent CLND and 61
(52 per cent) did not. Median follow-up for the two groups was 34 and 48 months respectively. In
univariable survival analysis, CLND did not significantly influence disease-specific survival (hazard ratio
(HR) 089, 95 per cent confidence interval 058 to 137; P = 0600). However, patients who did not
undergo CLND had more favourable prognostic factors. Matched-pair analysis, with matching for age,
Breslow thickness, tumour ulceration and SN tumour burden, showed that CLND had no influence
on survival (HR 086, 046 to 161; P = 0640). After adjusting for prognostic factors in multivariable
survival analyses, no difference in survival was found.
Conclusion: In these two cohorts of patients with SN-positive melanoma and prognostic heterogeneity,
outcome was not influenced by CLND.

Critical appraisal (Primer) tambahin tabel 1, tmr size

2. Apakah follow-up cukup lama dan

lengkap ? Tambahin surgery, result

(Sekunder)
1. Apakah digunakan kriteria outcome yang objektif
dan tidak berbias ?

2. Apakah ada penyesuaian/adjustment

terhadap faktor prognostik yang penting?

Hasil.
1. Bagaimana gambaran outcome menurut waktu ?

2. Seberapa tepat perkiraan

Prognosis?

APAKAH PENELITIAN INI DAPAT

DIAPLIKASIKAN?
1. Apakah pasien dalam penelitian ini serupa
dengan pasien kita?
YA.
2. Apakah hasil tersebut membantu memilih
atau menghindari terapi tertentu?
YA.
3. Apakah hasilnya membantu dalam
memberikan konseling kepada pasien saya?
YA.

 Terima Kasih
wassalam