Topar G, Eisendle K, Zelger B, Fritsch P
Clinical Department of Dermatology and Venereology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
Br J Dermatol. 2006 Jun;154(6):1080-7. doi: 10.1111/j.1365-2133.2006.07169.x.
Sentinel lymph node (SLN) biopsy is advocated as the standard of care for patients with primary melanoma. It is a procedure with few side-effects and provides valuable staging information about the regional lymphatics.
To investigate the prognostic value of SLN biopsy and to compare it with that of other known risk factors in primary melanoma.
One hundred and forty-nine patients with primary melanomas (tumour thickness >1.0 mm) underwent SLN biopsy between May 1998 and April 2004 at our department. This report summarizes the follow-up data of this cohort until October 2004.
SLN biopsies of 49 of 149 patients (33%) revealed micrometastatic disease. Of all clinical and histological criteria, only the clinical type of primary melanoma (11 of 19 patients with acrolentiginous melanomas) and the Clark level were predictive for SLN positivity. Progression was observed in 22 patients (15%). It was significantly associated with ulceration of the primary tumour, tumour thickness, clinical type and localization of the primary tumour, female sex and older age. In contrast, SLN positivity was not significantly associated with a higher risk of progression (eight of 49 SLN-positive vs. 14 of 100 SLN-negative patients; P = 0.807). Twelve of 149 patients (8%) died because of melanoma in the follow-up period. Significant criteria for death were ulceration of the tumour, clinical type and localization of the primary tumour, but not SLN positivity.
A high percentage of positive SLNs was observed in the patients with melanoma in our study (33%). The fractions of patients both with progressive disease and with tumour-related death were not significantly higher in patients with positive SLN than in those with negative SLN. We therefore conclude that the SLN status is not a reliable prognostic factor for progression of melanoma.
前哨淋巴结（SLN）活检被推荐为原发性黑色素瘤患者的标准治疗方法。该手术副作用少，可提供有关区域淋巴管的有价值的分期信息。
研究SLN活检的预后价值，并将其与原发性黑色素瘤的其他已知危险因素进行比较。
1998年5月至2004年4月期间，149例原发性黑色素瘤（肿瘤厚度>1.0mm）患者在我科接受了SLN活检。本报告总结了该队列截至2004年10月的随访数据。
149例患者中有49例（33%）的SLN活检显示有微转移疾病。在所有临床和组织学标准中，只有原发性黑色素瘤的临床类型（19例肢端雀斑样黑色素瘤患者中的11例）和克拉克分级可预测SLN阳性。22例患者（15%）出现病情进展。这与原发性肿瘤溃疡、肿瘤厚度、原发性肿瘤的临床类型和部位、女性性别以及年龄较大显著相关。相比之下，SLN阳性与更高的进展风险无显著相关性（49例SLN阳性患者中有8例，100例SLN阴性患者中有14例；P = 0.807）。149例患者中有12例（8%）在随访期间因黑色素瘤死亡。死亡的重要标准是肿瘤溃疡、原发性肿瘤的临床类型和部位，但不是SLN阳性。
在我们的研究中，黑色素瘤患者中SLN阳性的比例较高（33%）。SLN阳性患者中疾病进展和肿瘤相关死亡的比例并不显著高于SLN阴性患者。因此，我们得出结论，SLN状态不是黑色素瘤进展的可靠预后因素。
