1-2 毫米 Breslow 厚度的所有黑色素瘤患者都应该进行前哨淋巴结活检吗？

Should all patients with melanoma between 1 and 2 mm Breslow thickness undergo sentinel lymph node biopsy?

机构信息

Department of Surgery, University of Louisville, Louisville, Kentucky, USA.

出版信息

Cancer. 2010 Mar 15;116(6):1535-44. doi: 10.1002/cncr.24895.

DOI:10.1002/cncr.24895

PMID:20108306

Abstract

BACKGROUND

Sentinel lymph node (SLN) biopsy generally is recommended for patients who have melanoma with a Breslow thickness > or = 1 mm. Most patients with melanoma between 1 mm and 2 mm thick have tumor-negative SLNs and an excellent long-term prognosis. The objective of the current study was to evaluate prognostic factors in this subset of patients and determine whether all such patients require SLN biopsy.

METHODS

Patients with melanoma between 1 mm and 2 mm in Breslow thickness were evaluated from a prospective multi-institutional study of SLN biopsy for melanoma. Disease-free survival (DFS) and overall survival (OS) were evaluated by Kaplan-Meier analysis to compare patients with melanoma that measured from 1.0 mm to 1.59 mm (Group A) versus patients with melanoma that measured from > or = 1.6 mm to 2.0 mm thick (Group B). Univariate and multivariate analyses were performed to evaluate factors predictive of tumor-positive SLN status, DFS, and OS.

RESULTS

The current analysis included 1110 patients with a median follow-up of 69 months. SLN status was tumor-positive in 133 of 1110 patients (12%) including 66 of 762 patients (8.7%) in Group A and 67 of 348 patients (19.3%) in Group B (P < .0001). On multivariate analysis, age, Breslow thickness, and lymphovascular invasion were independently predictive of a tumor-positive SLN (P < .05). DFS (P < .0001) and OS (P = .0001) were significantly better for Group A than for Group B. When tumor thickness was treated as either a continuous variable (P < 0.0001) or a categorical variable (P < .0001), it was significantly predictive of DFS and OS. On multivariate analysis, Breslow thickness, age, ulceration, histologic subtype, regression, Clark level, and SLN status were significant factors predicting DFS; and Breslow thickness, age, primary tumor location, sex, ulceration, and SLN status were significant factors predicting OS (P < .05). A subgroup of patients who had tumors <1.6 mm in Breslow thickness, had no lymphovascular invasion, and were aged > or = 59 years had a low risk (5%) of tumor-positive SLN.

CONCLUSIONS

The current findings indicated that there is significant diversity in the biologic behavior of melanoma between 1 mm and 2 mm in Breslow thickness. SLN biopsy is recommended for all such patients to identify those with lymph node metastasis who are at the greatest risk of recurrence and mortality.

摘要

背景

前哨淋巴结（SLN）活检通常推荐用于厚度≥1mm 的黑色素瘤患者。大多数厚度在 1 至 2mm 之间的黑色素瘤患者的 SLN 无肿瘤转移，且长期预后良好。本研究旨在评估该亚组患者的预后因素，并确定所有此类患者是否均需要 SLN 活检。

方法

对来自黑色素瘤 SLN 活检的多机构前瞻性研究中厚度为 1 至 2mm 的黑色素瘤患者进行评估。通过 Kaplan-Meier 分析评估无病生存期（DFS）和总生存期（OS），比较 Breslow 厚度为 1.0 至 1.59mm（A 组）的患者和 Breslow 厚度为≥1.6 至 2.0mm（B 组）的患者。进行单因素和多因素分析以评估预测 SLN 肿瘤阳性状态、DFS 和 OS 的因素。

结果

目前的分析包括 1110 名患者，中位随访时间为 69 个月。1110 名患者中有 133 名（12%）SLN 状态为肿瘤阳性，包括 A 组的 66 名（8.7%）和 B 组的 67 名（19.3%）（P<.0001）。多因素分析显示，年龄、Breslow 厚度和脉管浸润是 SLN 肿瘤阳性的独立预测因素（P<.05）。DFS（P<.0001）和 OS（P=0.0001）在 A 组明显优于 B 组。当将肿瘤厚度作为连续变量（P<.0001）或分类变量（P<.0001）时，其与 DFS 和 OS 显著相关。多因素分析显示，Breslow 厚度、年龄、溃疡、组织学亚型、消退、Clark 水平和 SLN 状态是预测 DFS 的重要因素；Breslow 厚度、年龄、原发肿瘤位置、性别、溃疡和 SLN 状态是预测 OS 的重要因素（P<.05）。Breslow 厚度<1.6mm、无脉管浸润且年龄≥59 岁的患者肿瘤 SLN 阳性风险较低（5%）。