Vuylsteke Ronald J C L M, Borgstein Paul J, van Leeuwen Paul A M, Gietema Hester A, Molenkamp Barbara G, Statius Muller Markwin G, van Diest Paul J, van der Sijp Joost R M, Meijer Sybren
Department of Surgical Oncology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
Ann Surg Oncol. 2005 Jun;12(6):440-8. doi: 10.1245/ASO.2005.06.013. Epub 2005 Apr 19.
Even though 60% to 80% of melanoma patients with a positive sentinel lymph node (SLN) have no positive additional lymph nodes (ALNs), all these patients are subjected to an ALN dissection (ALND) with its associated morbidity. The aim of this study was to predict the absence of ALN metastases in patients with a positive SLN by using features of the primary melanoma and SLN tumor load.
Of 71 SLN-positive patients, 52 had metastasis limited to the SLN (group 1), and 19 had > or =1 positive ALN after ALND (group 2). The tumor load of the SLN was assessed by measuring the total surface area by computerized morphometry. Breslow thickness, ulceration and lymphatic invasion of the primary tumor, and total SLN metastatic area were tested as covariates predicting the absence of positive ALNs.
The mean SLN metastatic area was 1.18 mm(2) (group 1) and 3.39 mm(2) (group 2) (P = .003) and was the only significant and independent factor after multivariate analysis (P = .02). None of the patients with both a Breslow thickness <2.5 mm and an SLN metastatic area <.3 mm(2) had a positive ALN.
SLN metastatic area can be used to predict the absence of positive ALNs in melanoma patients. In this study, patients with a Breslow thickness <2.5 mm and an SLN tumor load <.3 mm(2 )seemed to have no positive ALN and had excellent survival. We hypothesize that this subgroup might not benefit from ALND. Prospective larger trials, using this model and randomizing between ALND and no ALND, should confirm this hypothesis.
尽管前哨淋巴结（SLN）阳性的黑色素瘤患者中有60%至80%没有其他阳性淋巴结（ALN），但所有这些患者都要接受ALN清扫术（ALND）及其相关的并发症。本研究的目的是通过利用原发性黑色素瘤的特征和SLN肿瘤负荷来预测SLN阳性患者是否存在ALN转移。
在71例SLN阳性患者中，52例转移局限于SLN（第1组），19例在ALND后有≥1个阳性ALN（第2组）。通过计算机形态测量法测量总面积来评估SLN的肿瘤负荷。将原发性肿瘤的Breslow厚度、溃疡和淋巴管浸润以及SLN转移总面积作为预测无阳性ALN的协变量进行检测。
SLN转移平均面积在第1组为1.18mm²，在第2组为3.39mm²（P = 0.003），并且是多变量分析后唯一显著且独立的因素（P = 0.02）。Breslow厚度<2.5mm且SLN转移面积<.3mm²的患者均无阳性ALN。
SLN转移面积可用于预测黑色素瘤患者是否存在阳性ALN。在本研究中，Breslow厚度<2.5mm且SLN肿瘤负荷<.3mm²的患者似乎没有阳性ALN且生存良好。我们推测该亚组患者可能无法从ALND中获益。使用该模型并在ALND和不进行ALND之间进行随机分组的前瞻性更大规模试验应证实这一假设。
