Wong Sandra L, Morton Donald L, Thompson John F, Gershenwald Jeffrey E, Leong Stanley P L, Reintgen Douglas S, Gutman Haim, Sabel Michael S, Carlson Grant W, McMasters Kelly M, Tyler Douglas S, Goydos James S, Eggermont Alexander M M, Nieweg Omgo E, Cosimi A Benedict, Riker Adam I, G Coit Daniel
Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA.
Ann Surg Oncol. 2006 Jun;13(6):809-16. doi: 10.1245/ASO.2006.03.058. Epub 2006 Apr 12.
Completion lymph node dissection (CLND) is considered the standard of care in melanoma patients found to have sentinel lymph node (SLN) metastasis. However, the therapeutic utility of CLND is not known. The natural history of patients with positive SLNs who do not undergo CLND is undefined. This multi-institutional study was undertaken to characterize patterns of failure and survival rates in these patients and to compare results with those of positive-SLN patients who underwent CLND.
Surgeons from 16 centers contributed data on 134 positive-SLN patients who did not undergo CLND. SLN biopsy was performed by using each institution's established protocols. Patients were followed up for recurrence and survival.
In this study population, the median age was 59 years, and 62% were male. The median tumor thickness was 2.6 mm, 77% of tumors had invasion to Clark level IV/V, and 33% of lesions were ulcerated. The primary melanoma was located on the extremities, trunk, and head/neck in 45%, 43%, and 12%, respectively. The median follow-up was 20 months. The median time to recurrence was 11 months. Nodal recurrence was a component of the first site of recurrence in 20 patients (15%). Nodal recurrence-free survival was statistically insignificantly worse than that seen in a contemporary cohort of patients who underwent CLND. Disease-specific survival for positive-SLN patients who did not undergo CLND was 80% at 36 months, which was not significantly different from that of patients who underwent CLND.
This study underscores the importance of ongoing prospective randomized trials in determining the therapeutic value of CLND after positive SLN biopsy in melanoma patients.
对于已发现前哨淋巴结（SLN）转移的黑色素瘤患者，完成淋巴结清扫术（CLND）被视为标准治疗方法。然而，CLND的治疗效用尚不清楚。未接受CLND的SLN阳性患者的自然病史尚不明确。本多机构研究旨在描述这些患者的失败模式和生存率，并将结果与接受CLND的SLN阳性患者进行比较。
来自16个中心的外科医生提供了134例未接受CLND的SLN阳性患者的数据。SLN活检采用各机构既定方案进行。对患者进行复发和生存随访。
在本研究人群中，中位年龄为59岁，62%为男性。中位肿瘤厚度为2.6mm，77%的肿瘤侵犯至Clark分级IV/V级，33%的病变有溃疡形成。原发性黑色素瘤分别位于四肢、躯干和头颈部的比例为45%、43%和12%。中位随访时间为20个月。中位复发时间为11个月。20例患者（15%）的复发首发部位包括淋巴结复发。未接受CLND的患者的无淋巴结复发生存率在统计学上比同期接受CLND的患者略差。未接受CLND的SLN阳性患者的36个月疾病特异性生存率为80%，与接受CLND的患者无显著差异。
本研究强调了进行前瞻性随机试验对于确定黑色素瘤患者SLN活检阳性后CLND治疗价值的重要性。
