Cascinelli Natale, Bombardieri Emilio, Bufalino Rosaria, Camerini Tiziana, Carbone Antonino, Clemente Claudio, Lenisa Leonardo, Mascheroni Luigi, Maurichi Andrea, Pennacchioli Elisabetta, Patuzzo Roberto, Santinami Mario, Tragni Gabrina
Nuclear Medicine Unit, Istituto Nazionale Tumori, Milan, Italy.
J Clin Oncol. 2006 Sep 20;24(27):4464-71. doi: 10.1200/JCO.2006.06.3198.
To evaluate the prognostic significance of sentinel node biopsy in the management of stage IB and II melanoma patients, and to evaluate the status of nonsentinel nodes as a "second step key factor" to assess the prognosis of these patients.
We conducted an analysis of data collected in a prospective database.
From February 1994 to June 2005, 1,108 consecutive patients with stage IB and II melanoma were submitted to sentinel node biopsy; 176 patients (15.9%) had occult node metastases. The frequency of positive nodes increased with increasing Breslow's thickness. The largest diameter of metastatic foci and their localization within the lymph node were associated with the risk of nonsentinel node metastases only. The 5-year survival of patients with positive sentinel nodes was 81.4% in patients with one positive node and 39.6% in patients with two positive nodes (P = .056). Multivariate analysis indicated that status of sentinel nodes is a key factor and that sex and Breslow's thickness maintain statistically significant relevance. Ulceration, which was associated with survival when considered as single factor (P < .001) had no impact on survival in the multivariate analysis (P = .10). To evaluate the relevance of metastases to nonsentinel nodes, we identified four groups of patients.
Evaluation of the sentinel node is a useful procedure to identify patients to be submitted for complete lymph node dissection. The procedure makes it possible to assess the best prognosis of patients.
评估前哨淋巴结活检在ⅠB期和Ⅱ期黑色素瘤患者治疗中的预后意义，并评估非前哨淋巴结状态作为评估这些患者预后的“第二步关键因素”的情况。
我们对前瞻性数据库中收集的数据进行了分析。
1994年2月至2005年6月，1108例连续的ⅠB期和Ⅱ期黑色素瘤患者接受了前哨淋巴结活检；176例患者（15.9%）有隐匿性淋巴结转移。阳性淋巴结的频率随Breslow厚度增加而增加。转移灶的最大直径及其在淋巴结内的定位仅与非前哨淋巴结转移风险相关。前哨淋巴结阳性患者中，一个阳性淋巴结患者的5年生存率为81.4%，两个阳性淋巴结患者的5年生存率为39.6%（P = 0.056）。多因素分析表明，前哨淋巴结状态是一个关键因素，性别和Breslow厚度仍具有统计学意义。溃疡作为单因素时与生存率相关（P < 0.001），但在多因素分析中对生存率无影响（P = 0.10）。为评估非前哨淋巴结转移的相关性，我们确定了四组患者。
评估前哨淋巴结是识别需要进行完整淋巴结清扫患者的有用方法。该方法能够评估患者的最佳预后。
