Xing Yan, Badgwell Brian D, Ross Merrick I, Gershenwald Jeffrey E, Lee Jeffrey E, Mansfield Paul F, Lucci Anthony, Cormier Janice N
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
Cancer. 2009 Jun 1;115(11):2505-13. doi: 10.1002/cncr.24290.
The objectives of this analysis were to compare various measures associated with lymph node (LN) dissection and to identify threshold values associated with disease-specific survival (DSS) outcomes in patients with melanoma.
Patients with lymph node-positive melanoma who underwent therapeutic LN dissection of the neck, axilla, and inguinal region were identified from the SEER database (1988-2005). We performed Cox multivariate analyses to determine the impact of the total number of LNs removed, number of negative LNs removed, and LN ratio on DSS. Multivariate cut-point analyses were conducted for each anatomic region to identify the threshold values associated with the largest improvement in DSS.
The LN ratio was significantly associated with DSS for all LN regions. The LN ratio thresholds resulting in the greatest difference in 5-year DSS were .07, .13, and .18 for neck, axillary, and inguinal regions, respectively, corresponding to 15, 8, and 6 LNs removed per positive lymph node. After adjustment for other clinicopathologic factors, the hazard ratios (HRs) were .53 (95% confidence interval [CI], .40 to .71) in the neck, .52 (95% CI, .42 to .65) in the axillary, and .47 (95% CI, .36 to .61) in the inguinal regions for patients who met the LN ratio threshold.
Among the prognostic factors examined, LN ratio was the best indicator of the extent of LN dissection, regardless of anatomic nodal region. These data provide evidence-based guidelines for defining adequate LN dissections in melanoma patients.
本分析的目的是比较与淋巴结（LN）清扫相关的各种指标，并确定黑色素瘤患者疾病特异性生存（DSS）结果相关的阈值。
从监测、流行病学和最终结果（SEER）数据库（1988 - 2005年）中识别接受颈部、腋窝和腹股沟区治疗性LN清扫的淋巴结阳性黑色素瘤患者。我们进行了Cox多变量分析，以确定切除的LN总数、切除的阴性LN数和LN比率对DSS的影响。对每个解剖区域进行多变量切点分析，以确定与DSS最大改善相关的阈值。
所有LN区域的LN比率均与DSS显著相关。导致5年DSS差异最大的LN比率阈值，颈部、腋窝和腹股沟区分别为0.07、0.13和0.18，分别对应每一个阳性淋巴结切除15个、8个和6个LN。在调整其他临床病理因素后，达到LN比率阈值的患者，颈部的风险比（HR）为0.53（95%置信区间[CI]，0.40至0.71），腋窝为0.52（95%CI，0.42至0.65），腹股沟区为0.47（95%CI，0.36至0.61）。
在所检查的预后因素中，无论解剖淋巴结区域如何，LN比率都是LN清扫范围的最佳指标。这些数据为定义黑色素瘤患者充分的LN清扫提供了循证指南。
