皮肤黑色素瘤患者腋窝或腹股沟前哨淋巴结活检后（无论是否进行了根治性淋巴结清扫）的生活质量。
Quality of life after axillary or groin sentinel lymph node biopsy, with or without completion lymph node dissection, in patients with cutaneous melanoma.
作者信息
de Vries Mattijs, Hoekstra Harald J, Hoekstra-Weebers Josette E H M
机构信息
Department of Surgical Oncology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
出版信息
Ann Surg Oncol. 2009 Oct;16(10):2840-7. doi: 10.1245/s10434-009-0602-6. Epub 2009 Jul 29.
BACKGROUND
The aim of this study was to asses quality of life (QoL) after axillary or inguinal sentinel lymph node biopsy (SLNB) with or without completion lymph node dissection (CLND) in patients with cutaneous melanoma by comparing patients to a norm group of the general population and by comparing QoL between four patient groups depending on surgical procedure and location, i.e., patients receiving an axillary or groin SLNB, or an axillary or groin CLND.
METHODS
Between 1995 and 2003, a total of 242 axillary and inguinal SLNBs were performed. Of the 127 patients eligible for the study, 116 patients participated (91%). QoL was measured by the 30-item European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the McGill Pain Questionnaire and the Groningen Activity Restriction Scale.
RESULTS
Median age at diagnosis was 50 (range, 18-77) years; median Breslow thickness 2.0 (range, 1-13) mm; median follow-up 56 (range, 4-94) months. SLNB only was performed in 89 patients (77%): 48 in the groin and 41 in the axilla. CLND was performed in 27 patients (23%): 13 in the axilla and 14 in the groin. More postoperative complications (13 vs. 5; P < 0.001) and lymphedema (10 vs. 8; P < 0.001) occurred in the CLND group than in the SLNB group. The total group of patients reported better physical (P < 0.001), role (P < 0.001), emotional (P < 0.001), and social functioning (P = 0.049), global QoL (P < 0.001), and less fatigue (P < 0.001) and pain (P < 0.001) than a German norm group. Analysis of variance revealed significant differences in role functioning (P = 0.02) and tendencies toward physical problems (P = 0.051) and fatigue (P = 0.051) between the four groups. Post hoc Bonferroni tests showed that the axillary CLND group had more problems than the axillary and inguinal SLNB groups. Kruskal-Wallis tests showed that the axillary CLND group reported most pain.
CONCLUSIONS
QoL in melanoma survivors after axillary or inguinal SLNB with or without CLND was better than that in a norm group. Patients who underwent CLND in the axilla after SLNB reported most problems.
背景
本研究的目的是通过将皮肤黑色素瘤患者与普通人群的正常组进行比较，并根据手术方式和部位比较四个患者组（即接受腋窝或腹股沟前哨淋巴结活检（SLNB）或腋窝或腹股沟淋巴结清扫术（CLND）的患者）之间的生活质量（QoL），来评估腋窝或腹股沟前哨淋巴结活检（无论是否进行根治性淋巴结清扫）后的生活质量。
方法
1995年至2003年期间，共进行了242例腋窝和腹股沟前哨淋巴结活检。在127例符合研究条件的患者中，116例患者参与（91%）。生活质量通过30项欧洲癌症研究与治疗组织生活质量问卷（EORTC QLQ-C30）、麦吉尔疼痛问卷和格罗宁根活动限制量表进行测量。
结果
诊断时的中位年龄为50岁（范围18 - 77岁）；中位Breslow厚度为2.0毫米（范围1 - 13毫米）；中位随访时间为56个月（范围4 - 94个月）。仅进行前哨淋巴结活检的患者有89例（77%）：48例在腹股沟，41例在腋窝。进行淋巴结清扫术的患者有27例（23%）：13例在腋窝，14例在腹股沟。淋巴结清扫术组比前哨淋巴结活检组出现更多的术后并发症（13例对5例；P < 0.001）和淋巴水肿（10例对8例；P < 0.001）。与德国正常组相比，患者总体在身体（P < 0.001）、角色（P < 0.001）、情感（P < 0.001）和社会功能（P = 0.049）、总体生活质量（P < 0.001）方面表现更好，疲劳（P < 0.001）和疼痛（P < 0.001）更少。方差分析显示四组之间在角色功能（P = 0.02）以及身体问题（P = 0.051）和疲劳（P = 0.051）方面存在显著差异。事后Bonferroni检验表明腋窝淋巴结清扫术组比腋窝和腹股沟前哨淋巴结活检组问题更多。Kruskal-Wallis检验表明腋窝淋巴结清扫术组报告的疼痛最多。
结论
腋窝或腹股沟前哨淋巴结活检（无论是否进行淋巴结清扫）后的黑色素瘤幸存者的生活质量优于正常组。前哨淋巴结活检后在腋窝进行淋巴结清扫术的患者报告的问题最多。
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