Kelemen P R, Wanek L A, Morton D L
John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, California 90404, USA.
Ann Surg Oncol. 1999 Mar;6(2):139-43. doi: 10.1007/s10434-999-0139-8.
To determine the effects of disrupting a nodal basin in patients with American Joint Committee on Cancer stage III melanoma with clinically palpable lymph nodes, we studied patients who underwent therapeutic lymph node dissection after excisional lymph node biopsy, after fine-needle aspiration (FNA) biopsy, or without a preoperative biopsy.
We performed a retrospective review of our patients with American Joint Committee on Cancer stage III melanoma who were treated between January 1972 and June 1995, using data acquired from our 8200-patient database. The study group included 670 patients with melanoma, with known primary tumors, who underwent therapeutic lymph node dissection for palpable nodal metastases diagnosed by open biopsy (227 patients), by FNA (66 patients), or by clinical observation without biopsy (377 patients). Regional node recurrence, 5-year disease-free survival, and overall survival rates were calculated.
The same-basin regional node recurrence rates were similar for the three groups (open biopsy, 4.6%; FNA, 3.2%; no biopsy, 4.6%; P = .14). The 5-year disease-free survival rates were 36.8% for the open-biopsy group, 29.6% for the FNA group, and 28.9% for the no-biopsy group (P = .08); corresponding 5-year overall survival rates were 40.6%, 43.9%, and 36.1%, respectively (P = .18). Multivariate analysis failed to identify preoperative biopsy as a significant risk factor. Matched-pair analysis using age, gender, primary tumor site, Breslow thickness, and tumor burden showed no differences in the 5-year disease-free survival rates (33% for the open-biopsy group vs. 27% for the FNA and no-biopsy groups, P = .42) and the 5-year overall survival rates (41% vs. 35%, P = .32).
For patients with melanoma with palpable regional adenopathy, histological confirmation of clinical suspicion with either FNA or excisional lymph node biopsy does not adversely affect survival or recurrence rates.
为了确定在临床可触及淋巴结的美国癌症联合委员会III期黑色素瘤患者中，破坏淋巴结区域的效果，我们研究了在切除性淋巴结活检、细针穿刺（FNA）活检后或未进行术前活检的情况下接受治疗性淋巴结清扫的患者。
我们对1972年1月至1995年6月期间接受治疗的美国癌症联合委员会III期黑色素瘤患者进行了回顾性研究，使用从我们8200例患者数据库中获取的数据。研究组包括670例已知原发性肿瘤的黑色素瘤患者，他们因通过开放性活检（227例患者）、FNA（66例患者）或临床观察未活检（377例患者）诊断出的可触及淋巴结转移而接受治疗性淋巴结清扫。计算区域淋巴结复发率、5年无病生存率和总生存率。
三组的同区域淋巴结复发率相似（开放性活检组为4.6%；FNA组为3.2%；未活检组为4.6%；P = 0.14）。开放性活检组的5年无病生存率为36.8%，FNA组为29.6%，未活检组为28.9%（P = 0.08）；相应的5年总生存率分别为40.6%、43.9%和36.1%（P = 0.18）。多变量分析未能将术前活检确定为显著危险因素。使用年龄、性别、原发性肿瘤部位、Breslow厚度和肿瘤负荷进行的配对分析显示，5年无病生存率（开放性活检组为33%，FNA组和未活检组为27%，P = 0.42）和5年总生存率（41%对35%，P = 0.32）没有差异。
对于有可触及区域淋巴结肿大的黑色素瘤患者，通过FNA或切除性淋巴结活检对临床怀疑进行组织学确认不会对生存率或复发率产生不利影响。
