Morton D L
John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA.
Ann Surg Oncol. 2001 Oct;8(9 Suppl):22S-28S.
Intraoperative lymphatic mapping and sentinel lymphadenectomy (LM/SL) is a minimally invasive technique to determine whether a primary melanoma has metastasized to the sentinel node in the regional drainage basin. The sentinel node is the first node that receives lymph from any primary solid neoplasm whose drainage pattern is determined by its anatomical site and by the normal variations in lymphatic anatomy. Data from an ongoing multicenter phase III trial indicate that LM/SL for melanoma is accurate and reproducible when undertaken after a 30-case learning phase during which LM/SL is followed by complete lymphadenectomy. Although the optimal postoperative management of patients with sentinel node micrometastases identified by immunohistochemical staining has not been determined, adjuvant vaccine immunotherapy is a promising nontoxic approach that takes advantage of melanoma's intrinsic immunogenicity. Among the current adjuvant immunotherapy trials is a multicenter phase III study of CancerVax vaccine, an allogeneic polyvalent melanoma cell vaccine; results will indicate whether this vaccine should become standard therapy after complete surgical resection of melanoma metastatic to sentinel nodes.
术中淋巴管造影和前哨淋巴结切除术（LM/SL）是一种微创技术，用于确定原发性黑色素瘤是否已转移至区域引流区域的前哨淋巴结。前哨淋巴结是首个接收来自任何原发性实体肿瘤淋巴液的淋巴结，其引流模式由肿瘤的解剖部位和淋巴管解剖结构的正常变异决定。一项正在进行的多中心III期试验数据表明，在经过30例病例的学习阶段（在此阶段，在LM/SL之后进行完整淋巴结切除术）后开展的黑色素瘤LM/SL准确且可重复。尽管免疫组化染色识别出的前哨淋巴结微转移患者的最佳术后管理方法尚未确定，但辅助疫苗免疫疗法是一种有前景的无毒方法，它利用了黑色素瘤固有的免疫原性。目前的辅助免疫疗法试验中，有一项关于CancerVax疫苗（一种同种异体多价黑色素瘤细胞疫苗）的多中心III期研究；研究结果将表明，在黑色素瘤转移至前哨淋巴结后进行完整手术切除后，这种疫苗是否应成为标准疗法。
