Karakousis Giorgos C, Gimotty Phyllis A, Botbyl Jeffrey D, Kesmodel Susan B, Elder David E, Elenitsas Rosalie, Ming Michael E, Guerry DuPont, Fraker Douglas L, Czerniecki Brian J, Spitz Francis R
Department of Surgery, University of Pennsylvania Health System, Abramson Cancer Center, Philadelphia, Pennsylvania 19104, USA.
Ann Surg Oncol. 2006 Apr;13(4):533-41. doi: 10.1245/ASO.2006.05.011. Epub 2006 Mar 7.
Most melanoma patients present with thin (<or=1.0 mm) lesions. Indications for sentinel lymph node (SLN) biopsy are not well defined for this group. Previously, we reported an association between mitotic rate (MR) and SLN positivity in these patients. The study was limited by a relatively small sample size and low statistical power. In this study, we evaluated a large population of patients with thin melanoma from the pre-SLN era to identify predictors of regional nodal disease (RND) that may serve as a surrogate for SLN positivity.
Eight hundred eighty-two patients evaluated between 1972 and 1991 were included in the study. Univariate and multivariate regression analyses were performed by using clinical and histological data to identify factors associated with RND. A multivariate logistic regression model was developed and applied to the previously reported group of patients with thin melanomas who underwent SLN biopsy between 1996 and 2004 for validation.
Thirty-eight patients (4.3%) had evidence of RND. In the multivariate analysis, a MR>0, vertical growth phase (VGP), male sex, and ulceration were statistically significant predictors of RND. Patients at the highest risk according to a classification tree analysis (VGP and MR>0) had an RND rate of 11.9%. The regression model developed predicted well the SLN status in the validation sample.
Investigation of a large pre-SLN population identified MR>0, ulceration, VGP, and male sex as independently predictive of RND in patients with thin melanomas. These factors may help to identify subgroups of these patients that have clinically significant risks of SLN positivity.
大多数黑色素瘤患者表现为薄（≤1.0 mm）病灶。对于这一群体，前哨淋巴结（SLN）活检的指征尚不明确。此前，我们报道了这些患者的有丝分裂率（MR）与SLN阳性之间的关联。该研究受样本量相对较小和统计效能较低的限制。在本研究中，我们评估了大量前SLN时代的薄型黑色素瘤患者，以确定可作为SLN阳性替代指标的区域淋巴结疾病（RND）预测因素。
研究纳入了1972年至1991年间评估的882例患者。使用临床和组织学数据进行单因素和多因素回归分析，以确定与RND相关的因素。建立了多因素逻辑回归模型，并应用于先前报道的1996年至2004年间接受SLN活检的薄型黑色素瘤患者组进行验证。
38例患者（4.3%）有RND证据。在多因素分析中，MR>0、垂直生长期（VGP）、男性性别和溃疡是RND的统计学显著预测因素。根据分类树分析（VGP和MR>0）风险最高的患者RND率为11.9%。所建立的回归模型在验证样本中对SLN状态预测良好。
对大量前SLN人群的研究确定，MR>0、溃疡、VGP和男性性别是薄型黑色素瘤患者RND的独立预测因素。这些因素可能有助于识别这些患者中具有临床显著SLN阳性风险的亚组。
