Kesmodel Susan B, Karakousis Giorgos C, Botbyl Jeffrey D, Canter Robert J, Lewis Robert T, Wahl Peter M, Terhune Kyla P, Alavi Abass, Elder David E, Ming Michael E, Guerry DuPont, Gimotty Phyllis A, Fraker Douglas L, Czerniecki Brian J, Spitz Francis R
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Ann Surg Oncol. 2005 Jun;12(6):449-58. doi: 10.1245/ASO.2005.04.027. Epub 2005 Apr 19.
Lymphatic mapping and sentinel lymphadenectomy (LM/SL) provide important prognostic information for patients with early-stage melanoma. Although the use of this technique in patients with thin melanomas (< or =1.00 mm) is not routine, risk factors that may predict sentinel lymph node (SLN) positivity in this patient population are under investigation. We sought to determine whether mitotic rate (MR) is associated with SLN positivity in thin-melanoma patients and, therefore, whether it may be used to risk-stratify and select patients for LM/SL.
Clinical and histopathologic variables were reviewed for 181 patients with thin melanomas who underwent LM/SL from January 1996 through January 2004. Univariate and multivariate logistic regression analyses were performed to identify factors associated with SLN positivity. Risk groups were defined on the basis of the development of a classification tree.
The overall SLN positivity rate was 5%. All patients with positive SLNs had an MR of >0. By univariate analysis, MR and thickness were significant predictors of SLN positivity. The association between MR and SLN positivity remained significant controlling for each of the other variables evaluated. On the basis of a classification tree, patients with an MR >0 and tumor thickness > or =.76 mm were identified as a higher-risk group, with an SLN positivity rate of 12.3%.
In patients with thin melanomas, MR >0 seems to be a significant predictor of SLN positivity that may be used to risk-stratify and select patients for LM/SL. To confirm these results, the predictive value of MR for SLN positivity needs to be validated in other populations of thin-melanoma patients.
淋巴绘图和前哨淋巴结切除术（LM/SL）为早期黑色素瘤患者提供重要的预后信息。尽管在薄型黑色素瘤（≤1.00 mm）患者中使用该技术并非常规操作，但对于这一患者群体中可能预测前哨淋巴结（SLN）阳性的危险因素正在进行研究。我们试图确定有丝分裂率（MR）是否与薄型黑色素瘤患者的SLN阳性相关，以及它是否可用于对患者进行风险分层并选择适合LM/SL的患者。
回顾了1996年1月至2004年1月期间接受LM/SL的181例薄型黑色素瘤患者的临床和组织病理学变量。进行单因素和多因素逻辑回归分析以确定与SLN阳性相关的因素。根据分类树的构建确定风险组。
总的SLN阳性率为5%。所有SLN阳性的患者MR均>0。单因素分析显示，MR和肿瘤厚度是SLN阳性的重要预测因素。在对其他评估变量进行控制后，MR与SLN阳性之间的关联仍然显著。根据分类树，MR>0且肿瘤厚度≥0.76 mm的患者被确定为高风险组，SLN阳性率为12.3%。
在薄型黑色素瘤患者中，MR>0似乎是SLN阳性的重要预测因素，可用于对患者进行风险分层并选择适合LM/SL的患者。为证实这些结果，MR对SLN阳性的预测价值需要在其他薄型黑色素瘤患者群体中进行验证。
