Kretschmer L, Hilgers R, Möhrle M, Balda B R, Breuninger H, Konz B, Kunte C, Marsch W C, Neumann C, Starz H
Department of Dermatology, Georg August University of Göttingen, v. Siebold-Str. 3, D-37075 Göttingen, Germany.
Eur J Cancer. 2004 Jan;40(2):212-8. doi: 10.1016/j.ejca.2003.07.003.
Early versus delayed excision of lymph node metastases is still being assessed in malignant melanoma. In the present retrospective, multicentre study, the outcome of 314 patients with positive sentinel lymphonodectomy (SLNE) was compared with the outcome of 623 patients with delayed lymph node dissection (DLND) of clinically enlarged lymph node metastases. In order to avoid the lead-time bias, survival was generally calculated from the excision of the primary tumour. Survival curves were constructed using the Kaplan-Meier product-limit estimate. Cox's proportional hazards model was used to perform a multivariate analysis of factors related to overall survival. Compared with SLNE and early performed complete lymph node dissection, DLND yielded a significantly higher number of lymph node metastases. Median and mean tumour thickness were nearly identical in the two therapy groups. The estimated 3-year overall survival rate was 80.1+/-2.8% (+/-standard error of the mean (SEM)) in patients with positive SLNs, and 67.6+/-1.9% in patients with DLND (5-year survival rates 62.5+/-5.5 and 50.2+/-5.4%, respectively). The difference between the two survival curves was statistically significant (P=0.002). Using multifactorial analysis, SLNE (P=0.000052), American Joint Committee on Cancer (AJCC) Breslow thickness category (P<0.000001), age (P=0.01) and gender (P=0.028) were independent predictors of overall survival. The location of the primary tumour (P=0.59) was non-significant. Considering only those centres with sufficient data for epidermal ulceration, this risk factor was also significant. In cutaneous malignant melanoma, early excision of lymphatic metastases, directed by the sentinel node procedure, provides a highly significant overall survival benefit.
恶性黑色素瘤中，淋巴结转移灶早期切除与延迟切除仍在评估中。在本项回顾性多中心研究中，将314例行前哨淋巴结切除术（SLNE）且结果为阳性的患者与623例对临床肿大的淋巴结转移灶行延迟淋巴结清扫术（DLND）的患者的结局进行了比较。为避免领先时间偏倚，生存率一般从原发肿瘤切除时开始计算。采用Kaplan-Meier乘积限估计法构建生存曲线。使用Cox比例风险模型对与总生存相关的因素进行多变量分析。与SLNE和早期进行的完整淋巴结清扫相比，DLND发现的淋巴结转移灶数量显著更多。两个治疗组的肿瘤厚度中位数和平均值几乎相同。前哨淋巴结阳性患者的估计3年总生存率为80.1±2.8%（±平均标准误（SEM）），DLND患者为67.6±1.9%（5年生存率分别为62.5±5.5%和50.2±5.4%）。两条生存曲线之间的差异具有统计学意义（P=0.002）。通过多因素分析，SLNE（P=0.000052）、美国癌症联合委员会（AJCC）Breslow厚度分类（P<0.000001）、年龄（P=0.01）和性别（P=0.028）是总生存的独立预测因素。原发肿瘤的位置（P=0.59）无统计学意义。仅考虑那些有足够数据用于评估表皮溃疡的中心时，该风险因素也具有统计学意义。在皮肤恶性黑色素瘤中，以前哨淋巴结手术为导向的早期切除淋巴转移灶可带来显著的总生存获益。
