[黑色素瘤前哨淋巴结活检：300例患者的预后价值及缺点]

de Vries M, Jager P L, Suurmeijer A J H, Plukker J T M, van Ginkel R J, Hoekstra H J

Afd. Chirurgische Oncologie, Universitair Medisch Centrum Groningen, Postbus 30.001, 9700 RB Groningen.

Ned Tijdschr Geneeskd. 2005 Aug 13;149(33):1845-51.

OBJECTIVE

The aim of this study was to evaluate the advantages and disadvantages of sentinel lymph node biopsy (SLNB) in patients with cutaneous melanoma.

DESIGN

Descriptive follow-up study.

METHOD

In the period 1995-2004, 300 patients with cutaneous melanoma (Breslow thickness: > or = 1.0 mm) underwent SLNB and, in case of a tumour-positive result, regional lymph node dissection. Results of the SLNB procedure, postoperative complications, follow-up, recurrences, disease-free survival and disease-specific survival were evaluated.

RESULTS

The SLNB detection rate was 99%. 85 patients had a tumour-positive SLNB (28%) and underwent completion regional lymph node dissection; 215 patients underwent SLNB alone. The rate of postoperative complications after SLNB was 7%. With a median follow up of 51 months, the false-negative rate was 11%. The recurrence rate was 23% (SLNB negative: 19%; SLNB positive 34%; p = 0.005). In-transit metastases were found in 4% of the SLNB-negative group and in 20% of the SLNB-positive group (p < 0.001). The 5-year disease-free survival and disease-specific survival rates were 79% and 86%, respectively, in SLNB-negative patients and 57% and 71%, respectively, in SLNB-positive patients. Multivariate analysis showed that the independent prognostic factors for disease-free survival were presence of ulceration (p < 0.001) and SLNB positivity (p < 0.01). Prognostic factors for overall survival were presence of ulceration (p < 0.001) and male sex (p < 0.05), but not the SLNB results. Multivariate analysis also showed that SLNB positivity (p < 0.001) and presence of ulceration (p < 0.01) were independent prognostic factors for developing in-transit metastases.

CONCLUSION

SLNB in patients with cutaneous melanoma is still only of prognostic value since survival benefit is not proven. Disadvantages of SLNB were the false-negative rate, the possibility of an increased risk of in-transit metastases in SLNB-positive patients, and postoperative complications. These must be kept in mind when offering patients SLNB.

目的

本研究旨在评估皮肤黑色素瘤患者前哨淋巴结活检（SLNB）的优缺点。

设计

描述性随访研究。

方法

在1995 - 2004年期间，300例皮肤黑色素瘤患者（Breslow厚度：≥1.0 mm）接受了前哨淋巴结活检，若活检结果为肿瘤阳性，则进行区域淋巴结清扫。评估前哨淋巴结活检的结果、术后并发症、随访情况、复发情况、无病生存率和疾病特异性生存率。

结果

前哨淋巴结活检的检出率为99%。85例患者前哨淋巴结活检结果为肿瘤阳性（28%），并接受了区域淋巴结清扫；215例患者仅接受了前哨淋巴结活检。前哨淋巴结活检术后并发症发生率为7%。中位随访51个月，假阴性率为11%。复发率为23%（前哨淋巴结活检阴性：19%；前哨淋巴结活检阳性：34%；p = 0.005）。前哨淋巴结活检阴性组中4%出现了途中转移，前哨淋巴结活检阳性组中20%出现了途中转移（p < 0.001）。前哨淋巴结活检阴性患者的5年无病生存率和疾病特异性生存率分别为79%和86%，前哨淋巴结活检阳性患者分别为57%和71%。多因素分析显示，无病生存的独立预后因素为溃疡的存在（p < 0.001）和前哨淋巴结活检阳性（p < 0.01）。总生存的预后因素为溃疡的存在（p < 0.001）和男性（p < 0.05），但不是前哨淋巴结活检结果。多因素分析还显示，前哨淋巴结活检阳性（p < 0.001）和溃疡的存在（p < 0.01）是发生途中转移的独立预后因素。