Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Groene Hilledijk 301, Kamer A1-41, 3075 EA Rotterdam, The Netherlands.
Nat Rev Clin Oncol. 2010 Aug;7(8):446-54. doi: 10.1038/nrclinonc.2010.100. Epub 2010 Jun 22.
There are two hypotheses to explain melanoma dissemination: first, simultaneous lymphatic and hematogeneous spread, with regional lymph nodes as indicators of metastatic disease; and second, orderly progression, with regional lymph nodes as governors of metastatic disease. The sentinel node (SN) has been defined as the first draining lymph node from a tumor and is harvested with the use of the triple technique and is processed by an extensive pathology protocol. The SN status is a strong prognostic factor for survival (83-94% for SN negative, 56-75% SN-positive patients). False-negative rates are considerable (9-21%). Preliminary results of the MSLT-1 trial did not demonstrate a survival benefit for the SN procedure, although a subgroup analysis indicates a possible benefit. A mathematical model has demonstrated 24% prognostic false positivity. SN tumor burden represents a heterogeneous patient population and is classified most frequently with the Starz, Dewar or Rotterdam Criteria. A completion lymph-node dissection might not be indicated in all SN-positive patients. Patients classified with metastases <0.1 mm by the Rotterdam Criteria have excellent survival rates. Ultrasound-guided fine-needle aspiration cytology is emerging as a staging tool for high-risk patients, but more research is necessary before this can change clinical practice.
一是同时发生的淋巴和血行扩散，区域淋巴结作为转移疾病的指标；二是有序进展，区域淋巴结作为转移疾病的管理者。前哨淋巴结（SN）被定义为肿瘤的第一个引流淋巴结，通过三重技术采集，并通过广泛的病理协议进行处理。SN 状态是生存的强有力预后因素（SN 阴性患者为 83-94%，SN 阳性患者为 56-75%）。假阴性率相当高（9-21%）。MSLT-1 试验的初步结果并未显示 SN 手术对生存有获益，尽管亚组分析表明可能有获益。一个数学模型表明，24%的预后假阳性。SN 肿瘤负荷代表了异质性的患者群体，最常根据 Starz、Dewar 或 Rotterdam 标准进行分类。并非所有 SN 阳性患者都需要进行完全淋巴结清扫术。根据 Rotterdam 标准分类为<0.1mm 转移的患者具有极好的生存率。超声引导下细针抽吸细胞学检查正在成为高危患者的分期工具，但在改变临床实践之前，还需要进行更多的研究。
