Oncology · Medical Literature
[Corrections] Correction to Lancet Oncol 2026; 27: 452–60
Abstract
Varey AHR, Weitemeyer MB, Gjorup CA, Lo SN, Williams GJ, Thompson JF. Assessment of survival benefit from sentinel node biopsy for melanoma: a systematic review and meta-analysis. Lancet Oncol 2026; 27: 452–60—In this Article, the PROSPERO registration number stated in the Summary and main text Methods should have been CRD42023494671. This correction has been made as of July 27, 2026.
Clinical relevance
In adults with cutaneous melanoma, does sentinel node biopsy (SNB) confer a statistically and clinically significant reduction in melanoma-specific mortality and disease recurrence compared with no SNB? __SNAPSHOT__ {"studyDesign":"Systematic review and meta-analysis of adjusted comparative studies (multivariable analyses, propensity score–matched cohorts, and one randomized controlled trial with adjusted analysis); random-effects models used throughout","setting":"International; multicenter and registry-based studies pooled from searches of Medline, Embase, Cochrane CENTRAL, and ClinicalTrials.gov up to January 8, 2025","sampleSize":"Primary outcome (melanoma-specific mortality): n = 40,287 across 13 adjusted studies (SNB: 21,160; no SNB: 19,127). Secondary outcome (recurrence): n = 11,625 across 9 adjusted studies. Total systematic review included 60 eligible studies.","population":"Adults (aged ≥18 years) with cutaneous melanoma who had data on SNB performance and survival outcomes; studies without comparative survival data were excluded","intervention":"Sentinel node biopsy (SNB) performed as part of melanoma staging and management","comparator":"No sentinel node biopsy","primaryOutcome":"Adjusted risk of death from melanoma (melanoma-specific mortality), expressed as hazard ratio","followUp":"Median follow-up across the 13 primary-outcome studies: 43.5 months (range 32.4–50.4 months)","fundingSource":"Not reported in the correction notice or abstract; the PROSPERO registration number (CRD42023494671) was corrected in the erratum dated July 27, 2026"}
Key findings
In the primary adjusted analysis of 13 studies (n = 40,287), SNB was associated with a statistically significant reduction in melanoma-specific mortality (HR 0.86, 95% CI 0.81–0.92; p < 0.0001), with low interstudy heterogeneity (I² = 16%). The 5-year melanoma-specific mortality analysis (5 studies, n = 27,540) yielded a consistent result (HR 0.84, 95% CI 0.78–0.90; p < 0.0001; I² = 15%). The 10-year melanoma-specific mortality analysis (2 studies, 3 estimates) was not statistically significant (HR 0.87, 95% CI 0.71–1.06; p = 0.17) and showed greater heterogeneity (I² = 41%), with the authors noting this likely reflects a sparse evidence base rather than an absence of benefit. For the secondary outcome of disease recurrence (9 adjusted studies, n = 11,625), SNB was associated with a significant 29% relative risk reduction (HR 0.71, 95% CI 0.66–0.76; p < 0.0001; I² = 23%). Sensitivity analyses confirmed that the primary result was not driven by any single study and was not dependent on the use of systemic therapy in the contributing studies. Egger's test for the primary outcome did not demonstrate significant publication bias (p = 0.251). Risk of bias was assessed using the Newcastle–Ottawa scale for non-randomized studies and the Cochrane risk-of-bias tool for the randomized trial. Evidence certainty was evaluated using GRADE. Absolute risk reduction, NNT, and adverse event data are not reported in the available abstract or secondary sources; no NNT can be calculated (labeled: not reported).
Practice implications
This meta-analysis provides the largest pooled adjusted estimate to date on the question of whether SNB confers a survival benefit in cutaneous melanoma—a question that has remained contested despite the procedure's widespread adoption for staging. The study established a statistically significant and consistent association between SNB and reduced melanoma-specific mortality (HR 0.86) and recurrence (HR 0.71) across studies with low heterogeneity. However, several important limitations constrain causal inference: the majority of included studies were non-randomized observational analyses, and although adjusted estimates were pooled, residual confounding cannot be excluded (individual patient data were not available). The 10-year mortality benefit was not statistically demonstrated, raising questions about the durability of effect in longer follow-up horizons—though this analysis rested on only two studies. The study population reflected adults with cutaneous melanoma broadly, but specific subgroups—such as patients receiving modern neoadjuvant immunotherapy or targeted therapy—may not be adequately represented in the evidence base, as many included studies predate the current adjuvant/neoadjuvant era. Whether the observed survival association is attributable to SNB per se (e.g., early regional disease control, accurate staging enabling adjuvant therapy selection) versus unmeasured confounding (e.g., healthier or earlier-stage patients being offered SNB) cannot be resolved by this design. The finding that benefit was not dependent on systemic therapy use across studies is reassuring but does not eliminate this concern. This summary is based on the published abstract and secondary reporting only; the full text, supplementary data, and GRADE certainty ratings were not directly reviewed, which limits definitive appraisal of evidence quality and absolute effect magnitudes. __LIMITATIONS__ Predominance of non-randomized observational studies; only one randomized trial contributed adjusted data, limiting causal inference despite statistical adjustment,Individual patient data not available; aggregate-level meta-analysis cannot fully account for within-study confounding or interaction effects,Residual confounding acknowledged by authors: patients selected for SNB may differ systematically from those who were not, despite multivariable and propensity score adjustments,Median follow-up of approximately 43.5 months is relatively short for a disease where late recurrences occur; 10-year mortality analysis was underpowered (n = 2 studies),Heterogeneity in the qualifying treatment era across included studies: variable use of adjuvant systemic therapy (immunotherapy, targeted therapy) may confound between-study comparisons,Absolute risk reduction and NNT not reported, limiting direct assessment of clinical magnitude,Generalizability uncertain for patients receiving modern neoadjuvant immunotherapy regimens, in whom the role and necessity of SNB is actively debated,Funding source not disclosed in available abstract or correction notice, precluding assessment of potential sponsorship bias,Data for some studies were extracted from digitized survival curves rather than primary numerical reporting, introducing potential extraction error,This structured summary is based on the correction notice and available abstract/secondary sources only; full text was not directly reviewed __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ This large systematic review and meta-analysis demonstrates that sentinel node biopsy in adults with cutaneous melanoma is associated with a statistically significant 14% relative reduction in melanoma-specific mortality (HR 0.86) and a 29% relative reduction in recurrence risk (HR 0.71), with low heterogeneity across adjusted studies. While these findings represent the most comprehensive pooled evidence to date in support of a SNB survival benefit, the predominance of non-randomized data and residual confounding preclude definitive causal conclusions; SNB remains standard of care for eligible patients, but its role in the modern immunotherapy era warrants continued prospective evaluation. Clinicians should note that a PROSPERO registration number correction was issued August 1, 2026 (corrected number: CRD42023494671); this erratum does not affect the reported results or conclusions.