Goydos James S, Patel Kapal N, Shih Weichung Joe, Lu Shou-En, Yudd Anthony P, Kempf Jack S, Bancila Edita, Germino F Joseph
Department of Surgery, UMDNJ-Robert Wood Johnson Medical School and the Division of Biometrics, The Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA.
J Am Coll Surg. 2003 Feb;196(2):196-204; discussion 204-5. doi: 10.1016/S1072-7515(02)01758-1.
We studied the patterns of recurrence of patients with only reverse transcriptase-polymerase chain reaction (RT-PCR) evidence of regional nodal spread to see whether or not proposed treatment interventions are likely to be effective.
One hundred seventy-five patients who underwent selective lymphadenectomy for clinical stage I and II melanomas were included in this analysis. We preserved a portion of each sentinel lymph node (SLN) in liquid nitrogen in the operating room and performed RT-PCR on the specimens to detect the melanoma/melanocyte-specific marker tyrosinase. We then compared the pattern of recurrence (regional dermal metastases, regional nodal recurrence, or distant metastatic spread) of the patients with histologically positive SLNs to that of patients who had histologically negative SLNs.
The mean followup time of the 175 patients was 33.83 months (SD = 15.94, median = 34.17, maximum = 62.95, minimum = 6.21). Thirty-four patients had at least one histologically positive SLN, and 17 of these patients had a recurrence (50%). Of the 141 patients that had histologically negative SLNs, 73 had SLNs that were also negative for tyrosinase by RT-PCR, and none of these patients had a recurrence. Of the 68 patients that had histologically negative but RT-PCR-positive SLNs, 14 had a recurrence (20.6%).
Because the pattern of recurrence of patients with only RT-PCR evidence of melanoma in SLNs was identical to that in patients who had histologically evident melanoma in the SLN and underwent subsequent completion lymphadenectomy, we conclude that completion lymphadenectomy might be ineffective in decreasing the recurrence rate of patients with only RT-PCR evidence of melanoma in SLNs.
我们研究了仅通过逆转录酶-聚合酶链反应（RT-PCR）有区域淋巴结转移证据的患者的复发模式，以确定所提出的治疗干预措施是否可能有效。
本分析纳入了175例因临床I期和II期黑色素瘤接受选择性淋巴结清扫术的患者。我们在手术室将每个前哨淋巴结（SLN）的一部分保存在液氮中，并对标本进行RT-PCR检测黑色素瘤/黑素细胞特异性标志物酪氨酸酶。然后我们比较了前哨淋巴结组织学阳性患者与前哨淋巴结组织学阴性患者的复发模式（区域皮肤转移、区域淋巴结复发或远处转移扩散）。
175例患者的平均随访时间为33.83个月（标准差=15.94，中位数=34.17，最大值=62.95，最小值=6.21）。34例患者至少有一个前哨淋巴结组织学阳性，其中17例患者复发（50%）。在141例前哨淋巴结组织学阴性的患者中，73例患者的前哨淋巴结RT-PCR检测酪氨酸酶也为阴性，这些患者均未复发。在68例前哨淋巴结组织学阴性但RT-PCR阳性的患者中，14例患者复发（20.6%）。
由于仅通过RT-PCR在前哨淋巴结中有黑色素瘤证据的患者的复发模式与前哨淋巴结中有组织学明显黑色素瘤并随后接受根治性淋巴结清扫术的患者相同，我们得出结论，根治性淋巴结清扫术可能无法有效降低仅通过RT-PCR在前哨淋巴结中有黑色素瘤证据的患者的复发率。
