Kruper Laura L, Spitz Francis R, Czerniecki Brian J, Fraker Douglas L, Blackwood-Chirchir Anne, Ming Michael E, Elder David E, Elenitsas Rosalie, Guerry Dupont, Gimotty Phyllis A
Melanoma Program of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Cancer. 2006 Nov 15;107(10):2436-45. doi: 10.1002/cncr.22295.
Sentinel lymph node (SLN) status is an important prognostic factor for survival for patients with primary cutaneous melanoma. To address the issue of selecting patients at high and low risk for a positive SLN, prognostic factors were sought that predict SLN involvement by examining characteristics of both the primary tumor and the patient within the context of a biological model of melanoma progression.
The study included 682 patients with primary vertical growth phase (VGP) melanoma and no clinical evidence of metastatic disease who underwent SLN biopsy (1995-2003). Logistic regression and classification tree analyses were used to investigate the association between SLN positivity and Breslow thickness, Clark level, tumor infiltrating lymphocytes (TIL), ulceration, mitotic rate (MR), lesion site, gender, and age. RESULTS.: In all, 88 of the 682 patients had > or =1 positive SLN (12.9%). In the multivariate analysis, MR, TIL, and thickness were found to be independent prognostic factors for SLN positivity. In the classification tree, four different risk groups were defined, ranging from minimal risk (2.1%) to high risk (40.4%). In lesions < r =2.0 mm, MR was important in risk-stratifying patients, and in lesions >2.0 mm TIL was important.
By incorporating biologically based variables such as VGP, TIL, and MR along with thickness into a prognostic model, both patients at high risk and minimal risk for SLN positivity can be identified. If validated, this model can be used in patient management and trial design to select patients to undergo or be spared SLN biopsy.
前哨淋巴结（SLN）状态是原发性皮肤黑色素瘤患者生存的重要预后因素。为了解决选择SLN阳性高风险和低风险患者的问题，通过在黑色素瘤进展的生物学模型背景下检查原发性肿瘤和患者的特征，寻找预测SLN受累的预后因素。
该研究纳入了682例原发性垂直生长期（VGP）黑色素瘤且无转移疾病临床证据的患者，这些患者接受了SLN活检（1995 - 2003年）。采用逻辑回归和分类树分析来研究SLN阳性与Breslow厚度、Clark分级、肿瘤浸润淋巴细胞（TIL）、溃疡、有丝分裂率（MR）、病变部位、性别和年龄之间的关联。
682例患者中，共有88例患者有≥1枚SLN阳性（12.9%）。在多变量分析中，MR、TIL和厚度被发现是SLN阳性的独立预后因素。在分类树中，定义了四个不同的风险组，从最低风险（2.1%）到高风险（40.4%）。在r≤2.0 mm的病变中，MR在患者风险分层中很重要，而在病变＞2.0 mm时，TIL很重要。
通过将基于生物学的变量如VGP、TIL和MR以及厚度纳入预后模型，可以识别出SLN阳性的高风险和最低风险患者。如果得到验证，该模型可用于患者管理和试验设计，以选择接受或免于SLN活检的患者。
