Assessment of survival benefit from sentinel node biopsy for melanoma: a systematic review and meta-analysis

Background It is unproven whether sentinel node biopsy (SNB) for people with cutaneous melanoma improves survival. This study aimed to establish whether there is a reduction in the risk of death from melanoma after SNB. Methods This systematic review and meta-analysis involved searches of Medline, Embase, Cochrane CENTRAL, and ClinicalTrials.gov (up to Jan 8, 2025) using terms for melanoma, SNB, and survival. Studies were included if they reported survival in adults (ie, aged ≥18 years) with melanoma who underwent SNB relative to those who did not, and excluded studies without these data, because survival risk in people with melanoma could not be calculated. Duplicate title review (by GJW and CAG) and data extraction (by GJW and MBW) were performed. The primary outcome was death from melanoma. Risk of bias was assessed using the Newcastle-Ottawa and Cochrane Collaboration tools. This study was registered with PROSPERO (number CRD4203494674). Findings From 1560 screened records, 60 studies were eligible for analysis. After the exclusion of one study with high selection bias meta-analysis, 13 studies (40 287 participants) reporting an adjusted risk were analysed and showed a significantly reduced risk of death from melanoma for people who underwent SNB: hazard ratio (HR) 0·86 (95% CI 0·81–0·92, p