Roulin D, Matter M, Bady P, Liénard D, Gugerli O, Boubaker A, Bron L, Lejeune F J
Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
Eur J Surg Oncol. 2008 Jun;34(6):673-9. doi: 10.1016/j.ejso.2007.07.197. Epub 2007 Sep 6.
To confirm the accuracy of sentinel node biopsy (SNB) procedure and its morbidity, and to investigate predictive factors for SN status and prognostic factors for disease-free survival (DFS) and disease-specific survival (DSS).
Between October 1997 and December 2004, 327 consecutive patients in one centre with clinically node-negative primary skin melanoma underwent an SNB by the triple technique, i.e. lymphoscintigraphy, blue-dye and gamma-probe. Multivariate logistic regression analyses as well as the Kaplan-Meier were performed.
Twenty-three percent of the patients had at least one metastatic SN, which was significantly associated with Breslow thickness (p<0.001). The success rate of SNB was 99.1% and its morbidity was 7.6%. With a median follow-up of 33 months, the 5-year DFS/DSS were 43%/49% for patients with positive SN and 83.5%/87.4% for patients with negative SN, respectively. The false-negative rate of SNB was 8.6% and sensitivity 91.4%. On multivariate analysis, DFS was significantly worsened by Breslow thickness (RR=5.6, p<0.001), positive SN (RR=5.0, p<0.001) and male sex (RR=2.9, p=0.001). The presence of a metastatic SN (RR=8.4, p<0.001), male sex (RR=6.1, p<0.001), Breslow thickness (RR=3.2, p=0.013) and ulceration (RR=2.6, p=0.015) were significantly associated with a poorer DSS.
SNB is a reliable procedure with high sensitivity (91.4%) and low morbidity. Breslow thickness was the only statistically significant parameter predictive of SN status. DFS was worsened in decreasing order by Breslow thickness, metastatic SN and male gender. Similarly DSS was significantly worsened by a metastatic SN, male gender, Breslow thickness and ulceration. These data reinforce the SN status as a powerful staging procedure.
确认前哨淋巴结活检（SNB）程序的准确性及其发病率，并研究前哨淋巴结状态的预测因素以及无病生存期（DFS）和疾病特异性生存期（DSS）的预后因素。
1997年10月至2004年12月期间，一个中心的327例临床淋巴结阴性的原发性皮肤黑色素瘤患者连续接受了三联技术即淋巴闪烁造影、蓝色染料和γ探测器引导下的前哨淋巴结活检。进行了多变量逻辑回归分析以及Kaplan-Meier分析。
23%的患者至少有一个转移前哨淋巴结，这与Breslow厚度显著相关（p<0.001）。前哨淋巴结活检的成功率为99.1%，发病率为7.6%。中位随访33个月，前哨淋巴结阳性患者的5年DFS/DSS分别为43%/49%，前哨淋巴结阴性患者为83.5%/87.4%。前哨淋巴结活检的假阴性率为8.6%，敏感性为91.4%。多变量分析显示，DFS因Breslow厚度（RR=5.6，p<0.001）、前哨淋巴结阳性（RR=5.0，p<0.001）和男性（RR=2.9，p=0.001）而显著恶化。转移前哨淋巴结的存在（RR=8.4，p<0.001）、男性（RR=6.1，p<0.001）、Breslow厚度（RR=3.2，p=0.013）和溃疡（RR=2.6，p=0.015）与较差的DSS显著相关。
前哨淋巴结活检是一种可靠的程序，具有高敏感性（91.4%）和低发病率。Breslow厚度是预测前哨淋巴结状态的唯一具有统计学意义的参数。DFS按Breslow厚度、转移前哨淋巴结和男性的顺序依次恶化。同样，DSS因转移前哨淋巴结、男性、Breslow厚度和溃疡而显著恶化。这些数据强化了前哨淋巴结状态作为一种有力的分期程序的地位。
