Callejo Peixoto Isabel, Meneses e Sousa José
Department of Surgery, Portuguese Institute of Cancer, Lisbon, Portugal.
Clin Transl Oncol. 2005 May;7(4):145-9. doi: 10.1007/BF02708751.
The diagnostic usefulness of sentinel lymph node biopsy (SLNB) has been well established, but its therapeutic value remains unproven. First introduced by Morton and colleagues, the SLNB procedure is now widely available, and markedly enhances our ability to pathologically stage the regional nodes. Although the SLN status is acknowledged as the most powerful indicator of prognosis in melanoma, there is no evidence to-date, of survival advantage for complete lymphadenectomy in SLN-positive patients. Also, there is no effective adjuvant therapy that could benefit these sentinel node-positive patients, as yet. Additionally, new data have emerged indicating a possible increase in local/in-transit recurrence following complete lymphadenectomy in sentinel node-positive patients. To understand fully and to evaluate these observations we need information from randomized controlled trials. Major changes have occurred following the latest revision of melanoma staging system (AJCC, 6th edition). Concerning N category, these include the incorporation of the number of metastatic lymph nodes, the tumour burden of nodal metastases, and the ulceration of the primary tumour. The data obtained from the new staging system will reflect differences in prognosis that were not previously emphasized and which, we hope, will serve as a guide to more accurate analysis of metastatic pathways in cutaneous melanoma as well as a rationale for new forms of treatment.
前哨淋巴结活检（SLNB）的诊断价值已得到充分证实，但其治疗价值仍未得到验证。SLNB程序最早由莫顿及其同事提出，如今已广泛应用，显著提高了我们对区域淋巴结进行病理分期的能力。尽管前哨淋巴结状态被认为是黑色素瘤预后的最有力指标，但迄今为止，尚无证据表明前哨淋巴结阳性患者行根治性淋巴结清扫术能带来生存优势。此外，目前尚无有效的辅助治疗方法能使这些前哨淋巴结阳性患者受益。另外，新数据显示，前哨淋巴结阳性患者行根治性淋巴结清扫术后，局部/区域复发可能增加。为了全面理解和评估这些观察结果，我们需要来自随机对照试验的信息。黑色素瘤分期系统（美国癌症联合委员会第6版）最新修订后发生了重大变化。关于N分类，这些变化包括纳入转移淋巴结数量、淋巴结转移的肿瘤负荷以及原发肿瘤的溃疡情况。从新分期系统获得的数据将反映出此前未被强调的预后差异，我们希望这些差异将有助于更准确地分析皮肤黑色素瘤的转移途径，并为新的治疗形式提供理论依据。
