van Poll Daan, Thompson John F, Colman Marjorie H, McKinnon J Gregory, Saw Robyn P M, Stretch Jonathan R, Scolyer Richard A, Uren Roger F
Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia.
Ann Surg Oncol. 2005 Aug;12(8):597-608. doi: 10.1245/ASO.2005.08.012. Epub 2005 Jun 16.
It has been suggested that performing a sentinel node biopsy (SNB) in patients with cutaneous melanoma increases the incidence of in-transit metastasis (ITM).
ITM rates for 2018 patients with primary melanomas > or =1.0 mm thick treated at a single institution between 1991 and 2000 according to 3 protocols were compared: wide local excision (WLE) only (n = 1035), WLE plus SNB (n = 754), and WLE plus elective lymph node dissection (n = 229).
The incidence of ITM for the three protocols was 4.9%, 3.6%, and 5.7%, respectively (not significant), and as a first site of recurrent disease the incidence was 2.5%, 2.4%, and 4.4%, respectively (not significant). The subset of patients who were node positive after SNB and after elective lymph node dissection also had similar ITM rates (10.8% and 7.1%, respectively; P = .11). On multivariate analysis, primary tumor thickness and patient age predicted ITM as a first recurrence, but type of treatment did not. Patients who underwent WLE only and who had a subsequent therapeutic lymph node dissection (n = 149) had an ITM rate of 24.2%, compared with 10.8% in patients with a tumor-positive sentinel node treated with immediate dissection (n = 102; P = .03).
Performing an SNB in patients with melanoma treated by WLE does not increase the incidence of ITM.
有人提出，对皮肤黑色素瘤患者进行前哨淋巴结活检（SNB）会增加途中转移（ITM）的发生率。
比较了1991年至2000年间在单一机构按照3种方案治疗的2018例原发性黑色素瘤厚度≥1.0 mm患者的ITM发生率：仅行广泛局部切除（WLE）（n = 1035）、WLE加SNB（n = 754）以及WLE加选择性淋巴结清扫（n = 229）。
三种方案的ITM发生率分别为4.9%、3.6%和5.7%（无显著差异），作为复发性疾病的首发部位，发生率分别为2.5%、2.4%和4.4%（无显著差异）。SNB后和选择性淋巴结清扫后淋巴结阳性的患者亚组的ITM发生率也相似（分别为10.8%和7.1%；P = 0.11）。多因素分析显示，原发性肿瘤厚度和患者年龄可预测ITM作为首次复发，但治疗方式不能。仅接受WLE且随后进行治疗性淋巴结清扫的患者（n = 149）的ITM发生率为24.2%，而立即进行清扫的前哨淋巴结肿瘤阳性患者（n = 102）的ITM发生率为10.8%（P = 0.03）。
对接受WLE治疗的黑色素瘤患者进行SNB不会增加ITM的发生率。
