Kang John C, Wanek Leslie A, Essner Richard, Faries Mark B, Foshag Leland J, Morton Donald L
Roy E. Coats Research Laboratories of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA 90404, USA.
J Clin Oncol. 2005 Jul 20;23(21):4764-70. doi: 10.1200/JCO.2005.20.537.
Recent reports by European investigators suggest that sentinel lymphadenectomy (SLND), a mainstay of melanoma diagnosis and treatment planning, increases the risk of in-transit metastasis (ITM) and should be abandoned. This study compared the incidence of ITM after wide local excision (WLE), WLE plus SLND (SLND), or WLE plus elective lymphadenectomy (ELND) for primary melanoma.
Review of our prospective database identified 4,412 patients who underwent WLE (n = 2,771), SLND (n = 1,016), or ELND (n = 625) for stage I/II melanoma (1971 through 2002). The incidence of ITM overall and as a first recurrence was examined before and after computerized prognostic matching of treatment groups. Intergroup statistical comparisons used chi(2) analysis and log-rank test.
The incidence of ITM increased with Breslow depth, Clark level, and T stage. Although overall incidence of ITM was significantly higher (P = .0008) after ELND (6.56%) versus WLE (3.36%) or SLND (3.64%), the ELND group had higher risk primaries. Treatment groups matched by T stage (1,875 patients; 625 per group) or by age, sex, Breslow depth, and primary location (1,680 patients; 560 per group), showed no significant differences in ITM overall or as a first recurrence.
There is no relationship between SLND and ITM. Recent reports to the contrary reflect analysis of significantly smaller cohorts not matched for confounding variables such as T stage. The phase III Multicenter Selective Lymphadenectomy Trial will definitively settle the issue; until then, use of SLND, the most accurate staging procedure for early-stage melanoma, should continue.
欧洲研究者最近的报告表明，前哨淋巴结切除术（SLND）作为黑色素瘤诊断和治疗规划的主要手段，会增加途中转移（ITM）的风险，应予以摒弃。本研究比较了原发性黑色素瘤行广泛局部切除（WLE）、WLE加SLND（SLND）或WLE加选择性淋巴结清扫术（ELND）后ITM的发生率。
回顾我们的前瞻性数据库，确定了4412例因I/II期黑色素瘤（1971年至2002年）接受WLE（n = 2771）、SLND（n = 1016）或ELND（n = 625）的患者。在对治疗组进行计算机预后匹配前后，检查了ITM的总体发生率以及作为首次复发的发生率。组间统计比较采用卡方分析和对数秩检验。
ITM的发生率随Breslow深度、Clark分级和T分期增加。虽然ELND后ITM的总体发生率（6.56%）显著高于WLE（3.36%）或SLND（3.64%）（P = 0.0008），但ELND组的原发肿瘤风险更高。按T分期匹配的治疗组（1875例患者；每组625例）或按年龄、性别、Breslow深度和原发部位匹配的治疗组（1680例患者；每组560例），在ITM总体发生率或作为首次复发的发生率方面无显著差异。
SLND与ITM之间没有关联。最近相反的报告反映了对明显较小队列的分析，这些队列未对T分期等混杂变量进行匹配。III期多中心选择性淋巴结清扫试验将最终解决这个问题；在此之前，应继续使用SLND，这是早期黑色素瘤最准确的分期方法。
