Gutzmer Ralf, Satzger Imke, Thoms Kai-Martin, Völker Bernward, Mitteldorf Christina, Kapp Alexander, Bertsch Hans Peter, Kretschmer Lutz
Department of Dermatology and Venereology, Skin Tumor Center Hannover (HTZH), Hannover Medical School, Hannover, Germany.
J Dtsch Dermatol Ges. 2008 Mar;6(3):198-203. doi: 10.1111/j.1610-0387.2007.06569.x. Epub 2007 Dec 17.
The value of the status of the sentinel lymph node (SLN) in patients with thick melanomas (Breslow thickness > or = 4 mm) is controversial.
Using Kaplan-Meier estimates and Cox regression models, we studied 152 patients with primary melanomas > or = 4 mm thickness who underwent sentinel lymph node excision (SLNE) at the university hospitals of Hannover and Göttingen, Germany, between 1998 and 2006.
The median tumor thickness was 5.2 (4-18) mm; 58.5% of primary melanomas were ulcerated. Micrometastasis to a SLN was found in 48.7%. The patients with positive SLNs were significantly younger than those with negative SLN (p = 0.01). Of the complete lymph node dissections, 32% contained positive non-SLN. The estimated 5 year recurrence-free survival was 42.5 +/- 5% (+/- standard error) (26.3 +/- 6.6% after positive SLNE, 58.7 +/- 7.1% after negative SLNE). The 5 year overall survival rate was 53.2 +/- 5.4% (37.5 +/- 8.1% after positive SLNE, 67.6 +/- 6.7% after negative SLNE). By multivariate analysis, the SLN was a highly significant predictor for overall survival (p = 0.007, relative risk 2.3, 95%, confidence interval 1.2-4.2). The overall survival was significantly associated with penetration of nodal metastases into the SLN > 0.3 mm (p = 0.001). Other parameters such as tumor thickness, ulceration, age and sex were not significant. In the subgroup of patients with negative SLN, neither tumor thickness nor ulceration was significant.
The status of the SLN represents the most important prognostic parameter in patients with thick melanomas, whereas other parameters such as tumor thickness and ulceration loose their prognostic value.
前哨淋巴结（SLN）状态在厚黑色素瘤（Breslow厚度≥4mm）患者中的价值存在争议。
我们采用Kaplan-Meier估计法和Cox回归模型，研究了1998年至2006年间在德国汉诺威和哥廷根大学医院接受前哨淋巴结切除（SLNE）的152例原发性黑色素瘤厚度≥4mm的患者。
肿瘤中位厚度为5.2（4 - 18）mm；58.5%的原发性黑色素瘤有溃疡形成。在前哨淋巴结中发现微转移的比例为48.7%。前哨淋巴结阳性的患者显著比前哨淋巴结阴性的患者年轻（p = 0.01）。在完整淋巴结清扫中，32%含有阳性非前哨淋巴结。估计的5年无复发生存率为42.5±5%（±标准误）（前哨淋巴结阳性的SLNE后为26.3±6.6%，前哨淋巴结阴性的SLNE后为58.7±7.1%）。5年总生存率为53.2±5.4%（前哨淋巴结阳性的SLNE后为37.5±8.1%，前哨淋巴结阴性的SLNE后为67.6±6.7%）。通过多因素分析，前哨淋巴结是总生存的高度显著预测因素（p = 0.007，相对风险2.3，95%置信区间1.2 - 4.2）。总生存与前哨淋巴结中淋巴结转移灶浸润深度>0.3mm显著相关（p = 0.001）。其他参数如肿瘤厚度、溃疡形成、年龄和性别则无显著意义。在前哨淋巴结阴性的患者亚组中，肿瘤厚度和溃疡形成均无显著意义。
前哨淋巴结状态是厚黑色素瘤患者最重要的预后参数，而其他参数如肿瘤厚度和溃疡形成则失去其预后价值。
