Division of Surgical Oncology, Department of Surgery, University of California at Davis, Sacramento, California 95817, USA.
J Surg Oncol. 2012 Dec;106(7):807-10. doi: 10.1002/jso.23169. Epub 2012 Jun 4.
Sentinel lymph node biopsy (SLNB) is the standard for evaluation of the draining lymphatic basin for intermediate thickness melanoma. Despite this, SLNB has not been uniformly adopted. We hypothesized that there are geographic areas of the United States where patients are less likely to receive SLNB.
The Surveillance, Epidemiology, and End Results database was queried for patients who underwent surgery for intermediate thickness cutaneous melanoma (Breslow thickness 1.00-4.00 mm) from 2004 to 2008. Patients were categorized according to geographic area based on the reporting registry. Multivariate logistic regression models predicted use of SLNB.
Entry criteria were met by 8957 patients. On multivariate analysis, patients from the South were less likely (OR 0.54, CI 0.48-0.62; P < 0.001) to receive a SLNB. Additional factors associated with a decreased likelihood of receiving a SLNB included head and neck primary tumor site, high or unknown serum LDH, Asian, Hispanic, Native American or unknown race, and increasing age.
Patients from the South were less likely to receive a SLNB for an intermediate thickness cutaneous melanoma. This report of geographic disparities on a national level should be confirmed locally to better guide interventions aimed at eliminating these disparities.
前哨淋巴结活检（SLNB）是评估中间厚度黑色素瘤引流淋巴结的标准方法。尽管如此，SLNB 并未得到普遍采用。我们假设在美国的某些地区，患者不太可能接受 SLNB。
我们对 2004 年至 2008 年间接受中间厚度皮肤黑色素瘤（Breslow 厚度 1.00-4.00mm）手术的患者进行了调查，这些患者来自监测、流行病学和最终结果数据库。根据报告的登记处，患者根据地理位置进行分类。多变量逻辑回归模型预测了 SLNB 的使用情况。
8957 名患者符合纳入标准。多变量分析显示，南部地区的患者接受 SLNB 的可能性较低（OR 0.54，CI 0.48-0.62；P<0.001）。其他与接受 SLNB 的可能性降低相关的因素包括头颈部原发肿瘤部位、高或未知血清 LDH、亚洲人、西班牙裔、美洲原住民或未知种族以及年龄增加。
来自南部地区的中间厚度皮肤黑色素瘤患者接受 SLNB 的可能性较低。本报告中关于国家层面的地理差异应在当地进行确认，以更好地指导旨在消除这些差异的干预措施。
