Federico Andrea C, Chagpar Anees B, Ross Merrick I, Martin Robert C G, Noyes R Dirk, Goydos James S, Beitsch Peter D, Urist Marshall M, Ariyan Stephan, Sussman Jeffrey J, McMasters Kelly M, Scoggins Charles R
Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292.
Arch Surg. 2008 Jul;143(7):632-7; discussion 637-8. doi: 10.1001/archsurg.143.7.632.
The number of nodal basins draining a primary cutaneous melanoma is not an independent predictor of outcome.
Post hoc analysis of patients entered into a randomized, prospective study.
Multi-institutional academic and community medical centers.
Patients aged 18 to 70 years with melanoma 1.0 mm or greater Breslow thickness.
Wide local excision and sentinel lymph node biopsy were performed on all patients; patients with sentinel lymph node metastases underwent completion lymphadenectomy. Patients with multiple-nodal basin drainage were compared with those with single-nodal basin drainage.
Sentinel lymph node status, locoregional recurrence-free survival, disease-free survival, and overall survival.
A total of 2060 patients with single-nodal basin drainage (n = 1709 [83% of cohort]) were included in the analysis, with a median follow-up of 50 months. On univariate analysis, the group with multiple-nodal basin drainage (n = 351) was associated with female sex and primary tumor regression (P < .001). In addition, multiple-nodal basin drainage was associated with truncal primary tumor location (73.2%), while single-nodal basin drainage was more common for extremity tumors (50.9%; P < .001). On multivariate analysis, there were no differences in the rate of sentinel lymph node metastasis, disease-free survival, or overall survival between the groups. Interestingly, locoregional recurrence was significantly worse in the single-nodal basin drainage group (P = .003).
Multiple-nodal basin drainage does not confer a worse prognosis for patients with cutaneous melanoma. In fact, single-nodal basin drainage appears to be associated with a greater risk of locoregional recurrence.
引流原发性皮肤黑色素瘤的淋巴结区域数量并非预后的独立预测因素。
对纳入一项随机前瞻性研究的患者进行事后分析。
多机构学术和社区医疗中心。
年龄在18至70岁之间、Breslow厚度为1.0毫米或更厚的黑色素瘤患者。
所有患者均接受了广泛局部切除和前哨淋巴结活检；前哨淋巴结转移患者接受了根治性淋巴结清扫术。将有多淋巴结区域引流的患者与单淋巴结区域引流的患者进行比较。
前哨淋巴结状态、局部区域无复发生存率、无病生存率和总生存率。
共有2060名单淋巴结区域引流的患者（n = 1709 [占队列的83%]）纳入分析，中位随访时间为50个月。单因素分析显示，多淋巴结区域引流组（n = 351）与女性及原发性肿瘤消退相关（P < .001）。此外，多淋巴结区域引流与躯干原发性肿瘤位置相关（73.2%），而单淋巴结区域引流在四肢肿瘤中更为常见（50.9%；P < .001）。多因素分析显示，两组在前哨淋巴结转移率、无病生存率或总生存率方面无差异。有趣的是，单淋巴结区域引流组的局部区域复发情况明显更差（P = .003）。
多淋巴结区域引流并不会使皮肤黑色素瘤患者的预后更差。事实上，单淋巴结区域引流似乎与局部区域复发风险更高相关。
