Department of Surgical Oncology, University Medical Center, Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
Eur J Surg Oncol. 2011 Aug;37(8):681-7. doi: 10.1016/j.ejso.2011.05.003. Epub 2011 Jun 1.
To assess the long-term outcome after sentinel lymph node biopsy (SLNB) in melanoma patients.
Between 1995-2009 450 melanoma patients underwent SLNB in a single center. Survival and prognostic factors were analyzed for 429 patients.
Median age was 53 (range 11-84) years. Median Breslow thickness was 2.4 (range 1-20) mm and 36% were ulcerated melanomas. Median follow-up time was 64.8 (range 2-174) months. A tumor-positive SLN was present in 140 patients (31%). Completion lymph node dissection (CLND) was performed in 119 patients and these patients were analyzed for recurrence and survival. 124 Patients (29%) relapsed during follow-up; 55 in the node-positive group who underwent CLND (55/119; 46%) and 69 in the node-negative group (69/310; 22%; p < 0.001). In the node-negative group 17 patients developed recurrence in the regional node field; false-negative rate 11%. On multivariate analysis strongest prognostic factors for disease free survival (DFS) were primary melanoma ulceration and SLN positivity (Hazard Ratio (HR) of 2.2 and 2.3; p < 0.001). For disease specific survival (DSS) the same was found to be true with an HR of 2.1 for ulceration and 2.0 for SLN positivity (p = 0.001 and p = 0.002 respectively). 10-Year DFS was 71% for node-negative patients compared with 48% for node-positive patients (p < 0.001). 10-Year DSS was 77% for node-negative patients compared to 60% for node-positive patients (p < 0.001).
This study shows a remarkably high percentage of tumor-positive SLN. The long-term follow-up data confirm that tumor-positive SLN patients have a worse DFS and DSS than tumor-negative SLN patients. Ulceration and SLN status proved to be the strongest prognostic factors for long-term DFS and DSS.
评估黑色素瘤患者前哨淋巴结活检（SLNB）的长期结果。
1995 年至 2009 年间，450 名黑色素瘤患者在一个中心进行了 SLNB。对 429 名患者的生存和预后因素进行了分析。
中位年龄为 53 岁（范围 11-84 岁）。中位 Breslow 厚度为 2.4 毫米（范围 1-20 毫米），36%的黑色素瘤溃疡。中位随访时间为 64.8 个月（范围 2-174 个月）。140 例患者的 SLN 呈阳性（31%）。119 例患者行淋巴结清扫术（CLND），对这些患者进行复发和生存分析。124 例患者（29%）在随访期间复发；55 例为淋巴结阳性组患者（55/119；46%），69 例为淋巴结阴性组患者（69/310；22%；p<0.001）。在淋巴结阴性组中，17 例患者在区域淋巴结区域复发；假阴性率为 11%。多因素分析显示，无病生存率（DFS）的最强预后因素是原发性黑色素瘤溃疡和 SLN 阳性（危险比（HR）分别为 2.2 和 2.3；p<0.001）。对于疾病特异性生存率（DSS），同样发现溃疡和 SLN 阳性的 HR 分别为 2.1 和 2.0（p=0.001 和 p=0.002）。与淋巴结阳性患者相比，淋巴结阴性患者的 10 年 DFS 为 71%（p<0.001）。与淋巴结阳性患者相比，淋巴结阴性患者的 10 年 DSS 为 77%（p<0.001）。
本研究显示 SLN 阳性肿瘤的比例非常高。长期随访数据证实，SLN 阳性肿瘤患者的 DFS 和 DSS 比 SLN 阴性肿瘤患者差。溃疡和 SLN 状态被证明是长期 DFS 和 DSS 的最强预后因素。
