Debarbieux S, Duru G, Dalle S, Béatrix O, Balme B, Thomas L
Department of Dermatology, Hotel Dieu 69288, Lyon CEDEX 02, France.
Br J Dermatol. 2007 Jul;157(1):58-67. doi: 10.1111/j.1365-2133.2007.07937.x. Epub 2007 May 14.
Sentinel lymph node (SLN) positivity has been found to be strongly associated with a poor prognosis in melanoma.
This large referral centre study was conducted: (i) to confirm the powerful prognostic value of SLN biopsy (SLNB); (ii) to correlate patient prognosis to the micromorphometric features of SLN metastasis in SLN-positive patients; and (iii) to correlate these micromorphometric features to the likelihood of positive completion lymph node dissection (CLND).
SLNB was performed in 455 cases of primary melanoma between January 1999 and December 2004; for patients with positive SLN, the following micromorphometric features were registered: size of the largest metastasis (two diameters), depth of metastasis, number of millimetric slices involved, maximum number of metastases on a single section, presence of intracapsular lymphatic invasion and extracapsular spread. Kaplan-Meier survival curves were compared with the log-rank test; multivariate analysis was performed using a Cox regression model. Dependence of CLND status on micromorphometric features of SLN was assessed by the chi(2) test and predictive values of the different features were evaluated by multivariate analysis using a logistic regression model.
A positive SLN was identified in 98 of our 455 cases. Survival was significantly shorter in SLN-positive patients than in SLN-negative patients. Extracapsular invasion was found to be an independent prognostic factor of disease-free survival; ulceration of the primary and the maximum diameter of the largest metastasis were identified as independent predictive factors of disease-specific survival. Age and the lowest diameter of the largest metastasis were identified as independent predictive criteria of positive CLND, whereas depth of metastasis was not. Positivity of CLND was not significantly associated with a worse prognosis.
Our study confirms the previously demonstrated strong prognostic value of SLNB. It also confirms the relationship between tumour burden in the SLN (evaluated by the maximum diameter of the largest metastasis) and clinical outcome. We point out a new micromorphometric feature of SLN, which seems to be predictive of CLND status: the lowest diameter of the largest metastasis.
前哨淋巴结（SLN）阳性已被发现与黑色素瘤的预后不良密切相关。
开展了这项大型转诊中心研究：（i）确认前哨淋巴结活检（SLNB）的强大预后价值；（ii）将患者预后与SLN阳性患者中SLN转移的微观形态学特征相关联；（iii）将这些微观形态学特征与阳性根治性淋巴结清扫术（CLND）的可能性相关联。
1999年1月至2004年12月期间，对455例原发性黑色素瘤患者进行了SLNB；对于SLN阳性的患者，记录了以下微观形态学特征：最大转移灶的大小（两个直径）、转移深度、受累毫米切片数量、单个切片上转移灶的最大数量、囊内淋巴管侵犯和囊外扩散情况。采用对数秩检验比较Kaplan-Meier生存曲线；使用Cox回归模型进行多变量分析。通过卡方检验评估CLND状态对SLN微观形态学特征的依赖性，并使用逻辑回归模型通过多变量分析评估不同特征的预测价值。
在我们的455例病例中，98例SLN为阳性。SLN阳性患者的生存期明显短于SLN阴性患者。囊外侵犯被发现是无病生存期的独立预后因素；原发灶溃疡和最大转移灶的最大直径被确定为疾病特异性生存期的独立预测因素。年龄和最大转移灶的最小直径被确定为CLND阳性的独立预测标准，而转移深度则不是。CLND阳性与预后较差无显著相关性。
我们的研究证实了先前证明的SLNB的强大预后价值。它还证实了SLN中的肿瘤负荷（通过最大转移灶的最大直径评估）与临床结果之间的关系。我们指出了SLN的一个新的微观形态学特征，它似乎可预测CLND状态：最大转移灶的最小直径。
