Department of Surgery, University of Perugia, 06100 Perugia, Italy.
In Vivo. 2011 May-Jun;25(3):439-43.
We examined the impact of sentinel lymph node (SLN) biopsy among patients with primary melanoma that exceeded 4.0 mm in Breslow thickness, treated in our Institution from 1998 until 2009.
According to Kaplan-Meier statistics, overall survival (OS) and disease-free survival (DFS) were assessed in patients with: i) disseminated disease at diagnosis with respect to patients undergoing SLN biopsy and ii) positive SLN and negative SLN. The effect of age, thickness and number of positive SLN on survival was also calculated.
Forty-three patients with thick melanoma were included (29 men and 14 women; mean age 65 ± 17 years, tumor thickness ranging from 4 to 20 mm). Thirteen patients (30%) were not eligible for SLN biopsy due to metastatic disease or poor clinical condition. Biopsy was performed on 30 patients: 14 with positive SLN (46.7%, group A) and 16 with negative SLN (53.3%, group B). Seven patients (50%) died in group A and 2 patients (13%) in group B (mean follow-up 28 and 59 months, respectively); all 7 patients in group A and no patient in group B died because of melanoma. OS and DFS were both significantly higher in group B than group A.
Our experience demonstrates a high rate of positive SLNs in patients with thick melanoma, and significant differences regarding the general outcomes between those with positive and negative SLNs, the latter group having a good prognosis despite the thick primary tumor. This observation stresses the importance of SLN biopsy as a staging tool in patients with thick melanoma.
我们研究了在我们机构于 1998 年至 2009 年间治疗的原发黑色素瘤厚度超过 4.0 毫米的患者中，前哨淋巴结（SLN）活检的影响。
根据 Kaplan-Meier 统计，对诊断时存在播散性疾病的患者（相对于接受 SLN 活检的患者）和 SLN 阳性和 SLN 阴性的患者进行了总生存（OS）和无病生存（DFS）评估。还计算了年龄、厚度和阳性 SLN 数量对生存的影响。
纳入 43 例厚型黑色素瘤患者（29 名男性和 14 名女性；平均年龄 65 ± 17 岁，肿瘤厚度 4 至 20 毫米）。由于转移性疾病或临床状况不佳，13 例患者（30%）不符合 SLN 活检条件。对 30 例患者进行了活检：14 例 SLN 阳性（46.7%，A 组）和 16 例 SLN 阴性（53.3%，B 组）。A 组中有 7 例（50%）患者死亡，B 组中有 2 例（13%）患者死亡（平均随访 28 和 59 个月）；A 组中所有 7 例患者和 B 组中无一例患者因黑色素瘤死亡。B 组的 OS 和 DFS 均明显高于 A 组。
我们的经验表明，厚型黑色素瘤患者的 SLN 阳性率较高，并且阳性和阴性 SLN 患者的总体结果存在显著差异，尽管原发肿瘤较厚，但后者预后良好。这一观察结果强调了 SLN 活检作为厚型黑色素瘤分期工具的重要性。
