Zogakis Theresa G, Essner Richard, Wang He-jing, Foshag Leland J, Morton Donald L
Roy E. Coats Research Laboratories, John Wayne Cancer Institute at Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, California, USA.
Ann Surg Oncol. 2007 May;14(5):1604-11. doi: 10.1245/s10434-006-9267-6. Epub 2007 Mar 1.
A tumor-negative sentinel lymph node (SLN) does not preclude recurrence of melanoma. We hypothesized that certain patient-related and tumor factors are predictive of a worse outcome in these patients.
Disease-free survival (DFS), overall survival (OS), and recurrence patterns were retrospectively analyzed in 773 patients who underwent lymphatic mapping and SLN biopsy for primary cutaneous melanoma at our institution between 1995 and 2002, and who had tumor-negative SLNs by standard pathological analysis. Patient sex, age, tumor site and thickness, ulceration status, Clark level, and histology were evaluated for their influence on outcome by univariate and multivariate Cox regression analysis and classification and regression tree analysis.
DFS and OS at 5 years were 88% and 93%, respectively. Sixty-nine (8.9%) of 773 patients developed recurrence. Three-year OS was lower in patients with distant recurrence (17.1%) than in those with local/regional recurrence (55.5%). By multivariate analysis, primary tumor thickness (P < .0001), site on head/neck versus trunk (P = .0093) versus extremity (P = .0042), and ulceration status (P = .0024) were independently significant for DFS; primary tumor thickness (P = .0106) and ulceration status (P = .0001) also were independently significant for OS. Classification and regression tree analysis demonstrated DFS was shortest in patients who had ulcerated tumors >2 mm.
Melanoma will recur in approximately 9% of patients with tumor-negative SLNs. Patients with thick, ulcerated melanomas on the head or neck have the highest risk for recurrence. This group should be followed closely for recurrence and considered for adjuvant therapy.
前哨淋巴结（SLN）肿瘤阴性并不能排除黑色素瘤复发。我们推测某些与患者和肿瘤相关的因素可预测这些患者的不良预后。
回顾性分析了1995年至2002年间在我院因原发性皮肤黑色素瘤接受淋巴绘图和SLN活检且经标准病理分析SLN肿瘤阴性的773例患者的无病生存期（DFS）、总生存期（OS）和复发模式。通过单因素和多因素Cox回归分析以及分类与回归树分析评估患者的性别、年龄、肿瘤部位和厚度、溃疡状态、Clark分级和组织学对预后的影响。
5年时的DFS和OS分别为88%和93%。773例患者中有69例（8.9%）出现复发。远处复发患者的3年OS（17.1%）低于局部/区域复发患者（55.5%）。多因素分析显示，原发性肿瘤厚度（P <.0001）、头颈部与躯干（P =.0093）与四肢（P =.0042）的部位以及溃疡状态（P =.0024）对DFS具有独立显著意义；原发性肿瘤厚度（P =.0106）和溃疡状态（P =.0001）对OS也具有独立显著意义。分类与回归树分析表明，肿瘤溃疡且厚度>2 mm的患者DFS最短。
SLN肿瘤阴性的患者中约9%会出现黑色素瘤复发。头颈部有厚的、溃疡的黑色素瘤患者复发风险最高。该组患者应密切随访复发情况并考虑辅助治疗。
