皮肤黑色素瘤前哨淋巴结活检：斯坦福大学的经验，1997 - 2004年

Sentinel lymph node biopsy for cutaneous melanoma: the Stanford experience, 1997-2004.

作者信息

Berk David R, Johnson Denise L, Uzieblo Alison, Kiernan Michaela, Swetter Susan M

机构信息

Department of Dermatology, Stanford University Medical Center, Stanford, California 94305, USA.

出版信息

Arch Dermatol. 2005 Aug;141(8):1016-22. doi: 10.1001/archderm.141.8.1016.

DOI:10.1001/archderm.141.8.1016

PMID:16103331

Abstract

OBJECTIVE

To review sentinel lymph node (SLN) data from Stanford University Medical Center from January 1, 1997, to January 1, 2004, including rates of SLN positivity according to 2002 American Joint Committee on Cancer (AJCC) tumor classification, relation to other clinical and pathologic prognostic factors, and rates and sites of melanoma recurrence.

DESIGN

Retrospective case series.

SETTING

Stanford University Medical Center and Stanford melanoma clinics.

PATIENTS

A total of 274 consecutive patients with primary melanoma who underwent SLN biopsy (SLNB) between January 1, 1997, and January 1, 2004, or who were referred to the Stanford melanoma clinics after SLNB and were followed up through March 2005.

INTERVENTIONS

All patients underwent standard wide local excision of their primary tumors and SLNB with intradermal injection of isosulfan blue dye and/or technetium sulfur colloid.

MAIN OUTCOME MEASURE

Rates of SLN positivity per 2002 AJCC tumor classification, relation to other clinical and pathologic prognostic factors, and rates and sites of melanoma recurrence in node-negative and node-positive patients.

RESULTS

Positive SLNs were detected in 39 (15%) of 260 cases, including 0 (0%) of 45 for cutaneous melanomas 1.0 mm thick or less (T1), 21 (18%) of 115 for melanomas 1.01 to 2.0 mm thick (T2), 12 (19%) of 64 for melanomas 2.01 to 4.0 mm thick (T3), and 5 (16%) of 32 for melanomas thicker than 4.0 mm (T4). Median Breslow depths were 1.89 mm for SLN-positive biopsy specimens and 1.50 mm for SLN-negative biopsy specimens (P = .07). The recurrence rate was 46% among SLN-positive patients, with a median time to recurrence of 8 months. Bivariate analysis revealed SLN positivity to be associated with AJCC tumor classification (P = .02), location on the trunk (P = .03), and presence of ulceration (P = .03). By multivariate logistic regression, ulceration (P = .01) was predictive of SLN positivity, whereas SLN status (P< .001), ulceration (P = .02), and location (P = .03) were predictive of recurrent disease.

CONCLUSION

Data from the past 8 years confirm the accuracy and prognostic value of SLNB in cutaneous melanoma and the low rate of regional nodal recurrence for SLN-negative patients.

摘要

目的

回顾1997年1月1日至2004年1月1日斯坦福大学医学中心的前哨淋巴结（SLN）数据，包括根据2002年美国癌症联合委员会（AJCC）肿瘤分类的SLN阳性率、与其他临床和病理预后因素的关系以及黑色素瘤复发率和复发部位。

设计

回顾性病例系列研究。

地点

斯坦福大学医学中心和斯坦福黑色素瘤诊所。

患者

共有274例原发性黑色素瘤患者，他们在1997年1月1日至2004年1月1日期间接受了前哨淋巴结活检（SLNB），或者在SLNB后被转诊至斯坦福黑色素瘤诊所并随访至2005年3月。

干预措施

所有患者均接受了原发性肿瘤的标准广泛局部切除以及通过皮内注射异硫蓝染料和/或锝硫胶体进行的SLNB。

主要观察指标

根据2002年AJCC肿瘤分类的SLN阳性率、与其他临床和病理预后因素的关系以及SLN阴性和阳性患者中黑色素瘤复发率和复发部位。

结果

260例患者中有39例（15%）检测到前哨淋巴结阳性，其中厚度为1.0 mm及以下（T1）的皮肤黑色素瘤45例中0例（0%）阳性，厚度为1.01至2.0 mm（T2）的黑色素瘤115例中有21例（18%）阳性，厚度为2.01至4.0 mm（T3）的黑色素瘤64例中有12例（19%）阳性，厚度超过4.0 mm（T4）的黑色素瘤32例中有5例（16%）阳性。前哨淋巴结阳性活检标本的Breslow深度中位数为1.89 mm，前哨淋巴结阴性活检标本为1.50 mm（P = 0.07）。前哨淋巴结阳性患者的复发率为46%，复发的中位时间为8个月。二元分析显示，前哨淋巴结阳性与AJCC肿瘤分类（P = 0.02）、躯干部位（P = 0.03）和溃疡的存在（P = 0.03）相关。通过多因素logistic回归分析，溃疡（P = 0.01）可预测前哨淋巴结阳性，而前哨淋巴结状态（P<0.001）、溃疡（P = 0.02）和部位（P = 0.03）可预测复发性疾病。