Eggermont Alexander M M, Gore Martin
Department of Surgical Oncology, Erasmus University Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
Semin Oncol. 2007 Dec;34(6):509-15. doi: 10.1053/j.seminoncol.2007.09.003.
The utility of adjuvant surgical procedures in the management of primary melanomas has been evaluated in a large number of phase III randomized trials. These trials have shown that wide margins, elective lymph node dissection, sentinel lymph node (SLN) biopsy, and prophylactic isolated limb perfusion (ILP) do not improve survival but may improve locoregional control. Based on the claim of providing a survival benefit, these surgical procedures cannot be considered standard of care in the routine management of primary melanoma. Regarding the role of SLN biopsy it must be stated that this procedure provides the best information on prognosis and provides us with an important tool to stratify for and study more homogeneous patient populations to evaluate adjuvant systemic therapies in randomized phase III trials. The utility of systemic adjuvant therapy remains marginal as a result of the fact that a lack of effective drugs in stage IV disease is reflected by a lack of effective adjuvant therapies in stage II-III melanoma. Thus far, chemotherapeutic drugs, immunostimulants, and various vaccines have all failed. Interferon (IFN) has an effect on relapse-free survival but not on overall survival. Thus its impact is judged by many to be too small to be considered standard of care. The population of patients that can benefit from IFN needs to be better defined by identifying new biomarkers by genomic and proteomic studies, which are ongoing.
大量的III期随机试验评估了辅助手术程序在原发性黑色素瘤治疗中的效用。这些试验表明，切缘广泛、选择性淋巴结清扫、前哨淋巴结（SLN）活检和预防性隔离肢体灌注（ILP）并不能提高生存率，但可能改善局部区域控制。基于提供生存获益的说法，这些手术程序在原发性黑色素瘤的常规治疗中不能被视为标准治疗方法。关于SLN活检的作用，必须指出，该程序能提供关于预后的最佳信息，并为我们提供了一个重要工具，以便在随机III期试验中对更同质的患者群体进行分层和研究，从而评估辅助性全身治疗。由于IV期疾病缺乏有效药物反映在II - III期黑色素瘤缺乏有效的辅助治疗上，全身辅助治疗的效用仍然有限。到目前为止，化疗药物、免疫刺激剂和各种疫苗均已失败。干扰素（IFN）对无复发生存率有影响，但对总生存率没有影响。因此，许多人认为其影响太小，不能被视为标准治疗方法。通过正在进行的基因组和蛋白质组学研究确定新的生物标志物，能够更好地界定可从IFN中获益的患者群体。
