van Akkooi A C J, de Wilt J H W, Verhoef C, Graveland W J, van Geel A N, Kliffen M, Eggermont A M M
Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, 301 Groene Hilledijk, 3075 EA, Rotterdam, The Netherlands.
Eur J Cancer. 2006 Feb;42(3):372-80. doi: 10.1016/j.ejca.2005.10.023. Epub 2006 Jan 5.
Methods to work-up sentinel nodes (SN) vary considerably between institutes. This single institution study evaluated the positive SN-identification rate of the EORTC Melanoma Group (MG) protocol and investigated the prognostic value of the SN status regarding disease-free survival (DFS) and overall survival (OS) and evaluated the locoregional control after the SN procedure. Multivariate and univariate analyses using Cox's proportional hazard regression model was employed to assess the prognostic value of covariates regarding DFS and OS. The positive SN-identification rate was 29% at a median Breslow thickness of 2.00 mm and the false-negative rate was 9.4%. Breslow thickness and ulceration of the primary correlated with SN status. SN status, ulceration and site of the primary tumour correlated with DFS. SN status and ulceration of the primary correlated with OS. The in-transit metastasis rate correlated with SN-positivity, Breslow thickness and ulceration. Projected 3-year OS was 95% in SN-negative and 74% in SN-positive patients. Transhilar bivalving of the SN with step sections from the central planes is simple and had a high SN-positive detection rate of about 30%. The SN status is the most important predictive value for DFS and OS. In-transit metastasis rates correlated with SN-positivity, Breslow thickness and ulceration of the primary.
各机构对前哨淋巴结（SN）的处理方法差异很大。这项单机构研究评估了欧洲癌症研究与治疗组织黑色素瘤小组（MG）方案的前哨淋巴结阳性识别率，调查了前哨淋巴结状态对无病生存期（DFS）和总生存期（OS）的预后价值，并评估了前哨淋巴结手术后的局部区域控制情况。使用Cox比例风险回归模型进行多变量和单变量分析，以评估协变量对DFS和OS的预后价值。在中位Breslow厚度为2.00 mm时，前哨淋巴结阳性识别率为29%，假阴性率为9.4%。原发灶的Breslow厚度和溃疡与前哨淋巴结状态相关。前哨淋巴结状态、溃疡和原发肿瘤部位与DFS相关。前哨淋巴结状态和原发灶溃疡与OS相关。途中转移率与前哨淋巴结阳性、Breslow厚度和溃疡相关。预计SN阴性患者的3年总生存率为95%，SN阳性患者为74%。从前平面进行连续切片对前哨淋巴结进行肝门部二分法操作简单，前哨淋巴结阳性检出率约为30%，较高。前哨淋巴结状态是DFS和OS最重要的预测指标。途中转移率与前哨淋巴结阳性、Breslow厚度和原发灶溃疡相关。
