Crowley N J, Seigler H F
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
Cancer. 1990 Dec 15;66(12):2522-7. doi: 10.1002/1097-0142(19901215)66:12<2522::aid-cncr2820661213>3.0.co;2-z.
A retrospective search of patients seen at the Duke Melanoma Clinic from 1970 to 1986 identified 308 clinically Stage I patients, with 4.0 to 10.0 mm cutaneous melanomas. Five-year and ten-year survival was 56% and 43%, respectively. Elective lymph node dissection (ELND) was done in 116 patients (37.7%); there was no difference in disease-free interval (DFI) or survival between these patients versus patients treated with wide excision only (P = 0.9). Thirty-two patients (27.6%) had pathologically positive nodes on ELND. These patients had a shorter DFI (P = 0.05) and survival (P = 0.03) compared with patients with negative node dissections. When further divided by Breslow's thickness, this difference persisted in patients with 4.0 to 6.0 mm lesions (P = 0.01). However, for thicker lesions (greater than 6.0 mm), there was no difference in survival between the node-negative and node-positive groups (P = 0.9). The mean follow-up was 7.1 years. Elective lymph node dissection was not done in 192 patients; 78 of these recurred first in the regional nodes. These 78 patients were compared with the 32 patients who had pathologically positive nodes by ELND to see if patient survival was improved by early removal of nodal disease. There was no difference in DFI (P = 0.5) or survival (P = 0.3) between these two groups. It is concluded that ELND may provide prognostic information for patients with thick cutaneous melanomas. However, there was no change in DFI or ultimate survival when patients were followed, and nodes removed when clinically positive. The authors do not recommend ELND for patients with thick melanomas because the risk of distant metastases outweighs any benefit of regional node dissection.
对1970年至1986年在杜克黑色素瘤诊所就诊的患者进行回顾性研究，共确定了308例临床I期患者，其皮肤黑色素瘤厚度为4.0至10.0毫米。五年和十年生存率分别为56%和43%。116例患者（37.7%）接受了选择性淋巴结清扫术（ELND）；这些患者与仅接受广泛切除术的患者相比，无病生存期（DFI）或生存率无差异（P = 0.9）。32例患者（27.6%）在ELND时病理检查发现淋巴结阳性。与淋巴结清扫阴性的患者相比，这些患者的DFI较短（P = 0.05），生存率也较低（P = 0.03）。当按Breslow厚度进一步划分时，这种差异在病变厚度为4.0至6.0毫米的患者中仍然存在（P = 0.01）。然而，对于较厚的病变（大于6.0毫米），淋巴结阴性和阳性组之间的生存率没有差异（P = 0.9）。平均随访时间为7.1年。192例患者未进行选择性淋巴结清扫术；其中78例首先在区域淋巴结复发。将这78例患者与通过ELND病理检查发现淋巴结阳性的32例患者进行比较，以观察早期切除淋巴结疾病是否能提高患者生存率。两组之间的DFI（P = 0.5）或生存率（P = 0.3）没有差异。得出的结论是，ELND可能为厚皮肤黑色素瘤患者提供预后信息。然而，对患者进行随访并在临床发现淋巴结阳性时进行切除，DFI或最终生存率并无变化。作者不建议对厚黑色素瘤患者进行ELND，因为远处转移的风险超过了区域淋巴结清扫的任何益处。
