Faries Mark B, Wanek Leslie A, Elashoff David, Wright Byron E, Morton Donald L
John Wayne Cancer Institute, 2200 Santa Monica Blvd., Santa Monica, CA 90404, USA.
Arch Surg. 2010 Feb;145(2):137-42. doi: 10.1001/archsurg.2009.271.
Thin primary lesions are largely responsible for the rapid increase in melanoma incidence, making identification of appropriate candidates for nodal staging in this group critically important. We hypothesized that common clinical variables may accurately estimate the risk of nodal metastasis after wide excision and determine the need for sentinel node biopsy.
Review of prospectively acquired data in a large melanoma database.
A tertiary referral center.
A total of 2211 patients with thin melanoma treated by wide local excision alone were identified in the database between January 1, 1971, and December 31, 2005. Of those, 1732 met entry criteria.
We examined the rate of regional nodal recurrence and the impact of clinical and demographic variables by univariate and multivariate analyses.
The overall nodal recurrence rate was 2.9%; median time to recurrence was 38.3 months. Univariate analysis of 1732 patients identified male sex (P < .001), increased Breslow thickness (P < .001), and increased Clark level (P < .001) as significant for nodal recurrence. Multivariate analysis identified male sex (hazard ratio, 3.5; 95% confidence interval, 1.8-7.0; P < .001), younger age (0.45; 0.24-0.86; P = .001), and increased Breslow thickness (2.5; 1.6-3.7; categorical P < .001) as significant for nodal recurrence. The Clark level was no longer significant (P = .63). Breslow thickness, age, and sex were used to develop a scoring system and nomogram for the risk of nodal involvement. Predictions ranged from 0.1% in the lowest-risk group to 17.4% in the highest-risk group.
Many patients with thin melanoma will have nodal recurrence after wide excision alone. Three simple clinical variables may be used to estimate recurrence risk and select patients for sentinel node biopsy.
薄的原发性皮损是黑色素瘤发病率迅速上升的主要原因，因此确定该组中适合进行淋巴结分期的患者至关重要。我们推测常见的临床变量可能准确估计广泛切除术后淋巴结转移的风险，并确定是否需要进行前哨淋巴结活检。
回顾一个大型黑色素瘤数据库中前瞻性收集的数据。
一家三级转诊中心。
在1971年1月1日至2005年12月31日期间，数据库中总共识别出2211例仅接受广泛局部切除治疗的薄黑色素瘤患者。其中，1732例符合纳入标准。
我们通过单因素和多因素分析研究了区域淋巴结复发率以及临床和人口统计学变量的影响。
总体淋巴结复发率为2.9%；复发的中位时间为38.3个月。对1732例患者进行单因素分析发现，男性（P <.001）、Breslow厚度增加（P <.001）和Clark分级增加（P <.001）与淋巴结复发显著相关。多因素分析确定男性（风险比，3.5；95%置信区间，1.8 - 7.0；P <.001）、较年轻年龄（0.45；0.24 - 0.86；P =.001）和Breslow厚度增加（2.5；1.6 - 3.7；分类变量P <.001）与淋巴结复发显著相关。Clark分级不再具有显著性（P =.63）。Breslow厚度、年龄和性别被用于制定淋巴结受累风险的评分系统和列线图。预测范围从最低风险组的0.1%到最高风险组的17.4%。
许多薄黑色素瘤患者在仅进行广泛切除后会出现淋巴结复发。三个简单的临床变量可用于估计复发风险并选择患者进行前哨淋巴结活检。
