Renzi C, Caggiati A, Mannooranparampil T J, Passarelli F, Tartaglione G, Pennasilico G M, Cecconi S, Potenza C, Pasquini P
Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI-IRCCS), Via Monti di Creta, 104, 00167 Rome, Italy.
Eur J Surg Oncol. 2007 Apr;33(3):364-9. doi: 10.1016/j.ejso.2006.10.017. Epub 2006 Nov 28.
Cutaneous squamous cell carcinoma (SCC) is the second most common skin cancer. The metastatic potential is generally low. However, there are subgroups of patients at higher risk, for whom sentinel lymph node biopsy (SLNB) might be useful. SLNB might allow the timely inclusion of high risk patients in more aggressive treatment protocols, sparing at the same time node-negative patients the morbidity of potentially unnecessary therapy. Our aim was to introduce the concept of SLNB for patients with high risk cutaneous SCC.
We examined a consecutive series of high risk cutaneous SCC patients undergoing SLNB at our large dermatological hospital, and performed a literature review and pooled analysis of all published cases of SLNB for cutaneous SCC.
Among the 22 clinically node-negative patients undergoing SLNB at our hospital, one patient (4.5%) showed a histologically positive sentinel node and developed recurrences during follow-up. Sentinel node-negative patients showed no metastases at a median follow-up of 17 months (range: 6-64). The incidence of positive sentinel nodes in previous reports ranged between 12.5% and 44.4%. Pooling together patients from the present and previous studies (total 83 patients), we calculated an Odds Ratio of 2.76 (95% CI 1.2-6.5; p=0.02) of finding positive sentinel nodes for an increase in tumor size from <2 cm to 2.1-3 cm to >3 cm.
Our case series and the pooled analysis support the concept that SLNB can be performed for high risk cutaneous SCC. Prospective multicenter studies are needed to examine the role, utility and cost-effectiveness of SLNB for this population.
皮肤鳞状细胞癌（SCC）是第二常见的皮肤癌。其转移潜能通常较低。然而，有一部分患者风险较高，前哨淋巴结活检（SLNB）对他们可能有用。SLNB 可能使高危患者及时纳入更积极的治疗方案，同时使淋巴结阴性的患者避免潜在不必要治疗的并发症。我们的目的是引入针对高危皮肤 SCC 患者的 SLNB 概念。
我们检查了在我们大型皮肤科医院接受 SLNB 的一系列连续高危皮肤 SCC 患者，并对所有已发表的皮肤 SCC 的 SLNB 病例进行了文献综述和汇总分析。
在我院接受 SLNB 的 22 例临床淋巴结阴性患者中，1 例患者（4.5%）前哨淋巴结组织学检查呈阳性，且在随访期间出现复发。前哨淋巴结阴性的患者在中位随访 17 个月（范围：6 - 64 个月）时未出现转移。既往报告中前哨淋巴结阳性的发生率在 12.5%至 44.4%之间。将本研究和既往研究的患者（共 83 例）汇总在一起，我们计算出肿瘤大小从<2 cm 增加到 2.1 - 3 cm 再到>3 cm 时，发现前哨淋巴结阳性的比值比为 2.76（95%可信区间 1.2 - 6.5；p = 0.02）。
我们的病例系列和汇总分析支持了高危皮肤 SCC 可进行 SLNB 的概念。需要进行前瞻性多中心研究来探讨 SLNB 对该人群的作用、效用和成本效益。
