[黑色素瘤患者的前哨淋巴结活检]

[Sentinel lymph node biopsy in patients with melanoma].

作者信息

Tomás-Mallebrera L, Rojo-España R, Marquina-Vila A, Gimeno-Clemente N, Morales-Suárez-Varela M M

机构信息

Hospital Universitario Dr. Peset, Valencia, España.

出版信息

Actas Dermosifiliogr. 2010 Jun;101(5):428-36.

PMID:20525486

Abstract

INTRODUCTION AND OBJECTIVES

The incidence of melanoma is currently increasing worldwide. One of the factors influencing disease prognosis is the presence of regional lymph node metastases. Sentinel lymph node biopsy attempts to identify subclinical lymph node metastasis as a prognostic factor in the disease. The aim of this study was to analyze differences between patients with melanoma for whom positive or negative results were obtained in sentinel lymph node biopsy and to assess the impact of the technique on disease prognosis.

MATERIAL AND METHODS

Sentinel lymph node biopsy was carried out in patients with melanoma of the following characteristics: Breslow thickness > or =1mm, Breslow thickness <1mm with ulceration, Clark level IV-V, or regression. Lymphadenectomy was performed in patients with positive sentinel node biopsy. Data were also collected on the following variables: sex, age, skin phototype, site and type of melanoma, Breslow depth, Clark level, ulceration, regression, cancer stage at diagnosis, TNM classification, change in cancer stage during follow-up, and death due to melanoma.

RESULTS

Positive sentinel node biopsies were recorded in 19.44% of patients. Positive results were associated with the following variables: nodular melanoma (crude odds ratio [ORc] compared with superficial spreading melanoma, 3.44; 95% confidence interval [CI], 1.33-8.90); Breslow thickness >2.0, for a thickness of 2.1-4.0 (ORc, 21.12; 95% CI, 2.60-172.03) and for a thickness >4.0 (ORc, 23.25; 95% CI, 2.44-221.73); Clark level IV (ORc, 8.73; 95% CI, 1.03-74.12); ulceration (ORc, 4.86; 95% CI, 1.58-14.90); T3 (ORc, 4.20; 95% CI, 1.52-11.63) and T4 (ORc, 4.67; 95% CI, 1.27-17.15) in the TNM classification; change in cancer stage during follow-up (ORc, 7.20; 95% CI, 2.25-22.99); and death due to melanoma (ORc, 8.67; 95% CI, 3.62-96.15).

CONCLUSIONS

These results confirm the prognostic importance of sentinel lymph node biopsy, which facilitates identification of patients with a greater tendency towards disease progression and death due to melanoma.

摘要

引言与目的

目前，黑色素瘤的发病率在全球范围内呈上升趋势。影响疾病预后的因素之一是区域淋巴结转移的存在。前哨淋巴结活检旨在识别亚临床淋巴结转移，作为该疾病的一个预后因素。本研究的目的是分析前哨淋巴结活检结果为阳性或阴性的黑色素瘤患者之间的差异，并评估该技术对疾病预后的影响。

材料与方法

对具有以下特征的黑色素瘤患者进行前哨淋巴结活检：Breslow厚度≥1mm、Breslow厚度<1mm且伴有溃疡、Clark分级IV-V级或有消退。前哨淋巴结活检结果为阳性的患者进行淋巴结清扫术。还收集了以下变量的数据：性别、年龄、皮肤光类型、黑色素瘤的部位和类型、Breslow深度、Clark分级、溃疡、消退、诊断时的癌症分期、TNM分类、随访期间癌症分期的变化以及因黑色素瘤死亡的情况。

结果

19.44%的患者前哨淋巴结活检结果为阳性。阳性结果与以下变量相关：结节性黑色素瘤（与浅表扩散性黑色素瘤相比，粗比值比[ORc]为3.44；95%置信区间[CI]为1.33 - 8.90）；Breslow厚度>2.0，厚度为2.1 - 4.0时（ORc为21.12；95% CI为2.60 - 172.03）以及厚度>4.0时（ORc为23.25；95% CI为2.44 - 221.73）；Clark分级IV级（ORc为8.73；95% CI为1.03 - 74.12）；溃疡（ORc为4.86；95% CI为1.58 - 14.90）；TNM分类中的T3（ORc为4.20；95% CI为1.52 - 11.63）和T4（ORc为4.67；95% CI为1.27 - 17.15）；随访期间癌症分期的变化（ORc为7.20；95% CI为2.25 - 22.99）；以及因黑色素瘤死亡（ORc为8.67；95% CI为3.62 - 96.15）。