Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109-5312, USA.
Cancer. 2012 Feb 15;118(4):1040-7. doi: 10.1002/cncr.26288. Epub 2011 Jul 19.
Sentinel lymph node biopsy (SLNB) has emerged as a widely used staging procedure for cutaneous melanoma. However, debate remains around the accuracy and prognostic implications of SLNB for cutaneous melanoma arising in the head and neck, as previous reports have demonstrated inferior results to those in nonhead and neck regions. Through the largest single-institution series of head and neck melanoma patients, the authors set out to demonstrate that SLNB accuracy and prognostic value in the head and neck region are comparable to other sites.
A prospectively collected database was queried for cutaneous head and neck melanoma patients who underwent SLNB at the University of Michigan between 1997 and 2007. Primary endpoints included SLNB result, time to recurrence, site of recurrence, and date and cause of death. Multivariate models were constructed for analyses.
Three hundred fifty-three patients were identified. A sentinel lymph node was identified in 352 of 353 patients (99.7%). Sixty-nine of the 353 (19.6%) patients had a positive SLNB. Seventeen of 68 patients (25%) undergoing completion lymphadenectomy after a positive SLNB result had at least 1 additional positive nonsentinel lymph node. Patients with local control and a negative SLNB failed regionally in 4.2% of cases. Multivariate analysis revealed positive SLNB status to be the most prognostic clinicopathologic predictor of poor outcome; hazard ratio was 4.23 for SLNB status and recurrence-free survival (P < .0001) and 3.33 for overall survival (P < .0001).
SLNB is accurate and its results are of prognostic importance for head and neck melanoma patients.
前哨淋巴结活检 (SLNB) 已成为一种广泛应用于皮肤黑色素瘤的分期程序。然而，对于发生在头颈部的皮肤黑色素瘤，SLNB 的准确性和预后意义仍存在争议，因为之前的报告显示其结果不如非头颈部区域。通过最大的单一机构系列头颈部黑色素瘤患者，作者旨在证明 SLNB 在头颈部区域的准确性和预后价值与其他部位相当。
通过前瞻性收集密歇根大学 1997 年至 2007 年间进行 SLNB 的头颈部皮肤黑色素瘤患者的数据库进行查询。主要终点包括 SLNB 结果、复发时间、复发部位以及死亡日期和原因。构建了多变量模型进行分析。
确定了 353 名患者。353 名患者中的 352 名（99.7%）确定了前哨淋巴结。353 名患者中有 69 名（19.6%）的 SLNB 为阳性。在 68 名 SLNB 阳性患者中，有 17 名（25%）在 SLNB 阳性结果后进行了完全淋巴结清扫术，至少有 1 个额外的阳性非前哨淋巴结。局部控制且 SLNB 为阴性的患者中有 4.2%的病例出现区域性失败。多变量分析显示，SLNB 状态是不良预后的最具预测性的临床病理因素；SLNB 状态与无复发生存率的风险比为 4.23（P<.0001），与总生存率的风险比为 3.33（P<.0001）。
SLNB 对头颈部黑色素瘤患者是准确的，其结果具有预后意义。
