***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND We evaluated the contribution of sentinel-node biopsy to outcomes in patients with newly diagnosed melanoma . METHODS Patients with a primary cutaneous melanoma were r and omly assigned to wide excision and postoperative observation of regional lymph nodes with lymphadenectomy if nodal relapse occurred , or to wide excision and sentinel-node biopsy with immediate lymphadenectomy if nodal micrometastases were detected on biopsy . RESULTS Among 1269 patients with an intermediate-thickness primary melanoma , the mean ( + /-SE ) estimated 5-year disease-free survival rate for the population was 78.3+/-1.6 % in the biopsy group and 73.1+/-2.1 % in the observation group ( hazard ratio for recurrence[corrected ] , 0.74 ; 95 % confidence interval [ CI ] , 0.59 to 0.93 ; P=0.009 ) . Five-year melanoma-specific survival rates were similar in the two groups ( 87.1+/-1.3 % and 86.6+/-1.6 % , respectively ) . In the biopsy group , the presence of metastases in the sentinel node was the most important prognostic factor ; the 5-year survival rate was 72.3+/-4.6 % among patients with tumor-positive sentinel nodes and 90.2+/-1.3 % among those with tumor-negative sentinel nodes ( hazard ratio for death , 2.48 ; 95 % CI , 1.54 to 3.98 ; P<0.001 ) . The incidence of sentinel-node micrometastases was 16.0 % ( 122 of 764 patients ) , and the rate of nodal relapse in the observation group was 15.6 % ( 78 of 500 patients ) . The corresponding mean number of tumor-involved nodes was 1.4 in the biopsy group and 3.3 in the observation group ( P<0.001 ) , indicating disease progression during observation . Among patients with nodal metastases , the 5-year survival rate was higher among those who underwent immediate lymphadenectomy than among those in whom lymphadenectomy was delayed ( 72.3+/-4.6 % vs. 52.4+/-5.9 % ; hazard ratio for death , 0.51 ; 95 % CI , 0.32 to 0.81 ; P=0.004 ) . CONCLUSIONS The staging of intermediate-thickness ( 1.2 to 3.5 mm ) primary melanomas according to the results of sentinel-node biopsy provides important prognostic information and identifies patients with nodal metastases whose survival can be prolonged by immediate lymphadenectomy . ( Clinical Trials.gov number , NCT00275496 [ Clinical Trials.gov ] . ) PURPOSE Low-dose ( LD ) interferon ( IFN ) alfa ( LDI ) has demonstrated a consistent disease-free survival benefit for patients with clinical ly lymph node-negative melanoma in clinical trials . However , the optimal duration of treatment is still under discussion , and no previous trial has evaluated this question specifically . A prolongation of LDI from 18 months to 60 months might be of clinical benefit for patients with intermediate or high-risk melanoma . PATIENTS AND METHODS Eight hundred fifty patients with resected cutaneous melanoma of at least 1.5 mm tumor thickness were included in this prospect i ve r and omized , multicenter trial in Germany and Austria . Patients had to be clinical ly lymph node-negative , and sentinel node biopsy ( SLNB ) was performed in a majority of cases . They were r and omly assigned to receive 3 MU IFNalpha2a three times a week subcutaneously for either 18 months ( arm A ) or 60 months ( arm B ) . Results Of 850 r and omly assigned patients , 840 were eligible for evaluation after a median follow-up of 4.3 years . Tumor thickness and other relevant prognostic factors were well balanced between both groups . SLNB was performed in 635 patients ( 75.6 % ) , with a positivity rate of 18.0 % in arm A and 17.5 % in arm B. Neither relapse-free survival ( arm A , 75.6 % v arm B , 72.6 % ; P = .72 ; hazard ratio , 1.05 ; 95 % CI , 0.80 to 1.39 ) nor distant-metastasis-free survival ( 81.9 % v 79.7 % ; P = .56 ; HR , 1.10 ; 95 % CI , 0.80 to 1.52 ) or overall survival ( 85.9 % v 84.9 % ; P = .86 ; HR , 1.03 ; 95 % CI , 0.71 to 1.50 ) showed significant differences . CONCLUSION A prolongation of conventional LDI therapy from 18 to 60 months showed no clinical benefit in patients with intermediate and high-risk primary melanoma The propensity score is the probability of treatment assignment conditional on observed baseline characteristics . The propensity score allows one to design and analyze an observational ( nonr and omized ) study so that it mimics some of the particular characteristics of a r and omized controlled trial . In particular , the propensity score is a balancing score : conditional on the propensity score , the distribution of observed baseline covariates will be similar between treated and untreated subjects . I describe 4 different propensity score methods : matching on the propensity score , stratification on the propensity score , inverse probability of treatment weighting using the propensity score  , and covariate adjustment using the propensity score . I describe balance diagnostics for examining whether the propensity score model has been adequately specified . Furthermore , I discuss differences between regression-based methods and propensity score-based methods for the analysis of observational data . I describe different causal average treatment effects and their relationship with propensity score analyses Objective : The objective of this study was to evaluate , in an international multicenter phase III trial , the accuracy , use , and morbidity of intraoperative lymphatic mapping and sentinel node biopsy ( LM/SNB ) for staging the regional nodal basin of patients with early-stage melanoma . Summary Background Data : Since our introduction of LM/SNB in 1990 , this technique has been widely adopted and has become part of the American Joint Committee on Cancer ( AJCC ) staging system . Eleven years ago , the authors began the international Multicenter Selective Lymphadenectomy Trial ( MSLT-I ) to compare 2 treatment approaches : wide excision ( WE ) plus LM/SNB with immediate complete lymphadenectomy ( CLND ) for sentinel node ( SN ) metastases , and WE plus postoperative observation with CLND delayed until the subsequent development of clinical ly evident nodal metastases . Methods : After each center achieved 85 % accuracy of SN identification during a 30-case learning phase , patients with primary cutaneous melanoma ( ≥1 mm with Clark level ≥III , or any thickness with Clark level ≥IV ) were r and omly assigned in a 4:6 ratio to WE plus observation ( WEO ) with delayed CLND for nodal recurrence , or to WE plus LM/SNB with immediate CLND for SN metastasis . The accuracy of LM/SNB was determined by comparing the rates of SN identification and the incidence of SN metastases in the LM/SNB group versus the subsequent development of nodal metastases in the regional nodal basin of those patients with tumor-negative SNs . Early morbidity of LM/SNB was evaluated by comparing complication rates between the 2 treatment groups . Trial accrual was completed on March 31 , 2002 , after enrollment of 2001 patients . Results : Initial SN identification rate was 95.3 % overall : 99.3 % for the groin , 95.3 % for the axilla , and 84.5 % for the neck basins . The rate of false-negative LM/SNB during the trial phase , as measured by nodal recurrence in a tumor-negative dissected SN basin , decreased with increasing case volume at each center : 10.3 % for the first 25 cases versus 5.2 % after 25 cases . There were no operative mortalities . The low ( 10.1 % ) complication rate after LM/SNB increased to 37.2 % with the addition of CLND ; CLND also increased the severity of complications . Conclusions : LM/SNB is a safe , low-morbidity procedure for staging the regional nodal basin in early melanoma . Even after a 30-case learning phase and 25 additional LM/SNB cases , the accuracy of LM/SNB  continues to increase with a center 's experience . LM/SNB should become st and ard care for staging the regional lymph nodes of patients with primary cutaneous melanoma Background In the United Kingdom ( UK ) , there is an extensive market for the class ' A ' drug heroin . Many heroin users spend time in prison . People addicted to heroin often require prescribed medication when attempting to cease their drug use . The most commonly used detoxification agents in UK prisons are buprenorphine , dihydrocodeine and methadone . However , national guidelines do not state a detoxification drug of choice . Indeed , there is a paucity of research evaluating the most effective treatment for opiate detoxification in prisons . This study seeks to address the paucity by evaluating routinely used interventions amongst drug using prisoners within UK prisons . Methods / Design The Leeds Evaluation of Efficacy of Detoxification Study ( LEEDS ) Prisons Pilot Study will use r and omised controlled trial methodology to compare the open use of buprenorphine and dihydrocodeine for opiate detoxification , given in the context of routine care , within HMP Leeds . Prisoners who are eligible and give informed consent will be entered into the trial . The primary outcome measure will be abstinence status at five days post detoxification , as determined by a urine test . Secondary outcomes during the detoxification and then at one , three and six months post detoxification will be recorded 9603 Background : Emotional state has been linked to cancer survival , but its influence on the outcome of early melanoma is unclear . The Multicenter Selective Lymphadenectomy Trial ( MSLT-I ) r and omized patients with clinical ly localized cutaneous melanoma to wide local excision ( WEX ) plus observation or to WEX plus sentinel lymph node biopsy ( SNB ) .  Clinical endpoints included disease-specific and disease-free survival . A sub study of this phase III trial evaluated the impact of mood state on survival , and the impact of recurrence on mood state . METHODS Patients were asked to complete a  65-  question form within 6 months of enrollment ( baseline ) and every 12 months thereafter . This question naire measured 6 identifiable mood states ( vigor-activity , tension-anxiety , depression , anger-hostility , fatigue-inertia , confusion-bewilderment ) of the Profile of Mood States ( POMS ) , a vali date d mood scale for assessing responses to therapy . Self-reported data from the question naires were linked to demographic and clinical variables . RESULTS Of 2,001 patients accrued to MSLT-I , 1,620 completed the question naire at baseline . The baseline distribution of POMS variables was similar in the two treatment arms ( data not shown ) . Patients with more vigor at baseline had a significantly longer disease-free and overall survival ( Table ) , even after adjusting for age , tumor thickness , site , and ulceration status ( p < 0.001 ) . Among 136 patients who completed a question naire within 6 months after recurrence , comparison of baseline and post-recurrence responses revealed significant changes in mood state : tension , fatigue and confusion increased , whereas vigor decreased ( p = 0.0004 , 0.0171 , 0.0089 , and 0.0028 , respectively ) . CONCLUSIONS Vigor , a measure of energy and optimism , is directly correlated with disease-free and overall survival in early melanoma . The negative impact of recurrence on mood state suggests that SNB as a tool for preventing recurrence might also improve mood state and psychological well-being . Supported by NIH CA29605 . [ Table : see text ] No significant financial relationships to disclose BACKGROUND Sentinel-node biopsy , a minimally invasive procedure for regional melanoma staging , was evaluated in a phase 3 trial . METHODS We evaluated outcomes in 2001 patients with primary cutaneous melanomas r and omly assigned to undergo wide excision and nodal observation , with lymphadenectomy for nodal relapse ( observation group ) , or wide excision and sentinel-node biopsy , with immediate lymphadenectomy for nodal metastases detected on biopsy ( biopsy group ) . Results No significant treatment-related difference in the 10-year melanoma-specific survival rate was seen in the overall study population ( 20.8 % with and 79.2 % without nodal metastases ) . Mean ( ± SE ) 10-year disease-free survival rates were significantly improved in the biopsy group , as compared with the observation group , among patients with intermediate-thickness melanomas , defined as 1.20 to 3.50 mm ( 71.3 ± 1.8 % vs. 64.7 ± 2.3 % ; hazard ratio for recurrence or metastasis , 0.76 ; P=0.01 ) , and those with thick melanomas , defined as > 3.50 mm ( 50.7 ± 4.0 % vs. 40.5 ± 4.7 % ; hazard ratio , 0 
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We expect that overall survival data will be available in a future up date of this review .Disease-free survival and rate of local and regional recurrence favoured SLNB in both groups of participants with intermediate-thickness and thick melanomas but short-term surgical morbidity was higher in the SLNB group , especially with regard to complications in the nodal basin .
Currently this evidence is not sufficient to document a benefit of SLNB when compared to observation in individuals with primary localised cutaneous melanoma