法国基于人群的研究：伴区域淋巴结转移黑色素瘤的诊断与治疗。

Diagnosis and management of melanoma with regional lymph node metastases: a population-based study in France.

机构信息

Service de Dermatologie, Hôpital Robert Debré, Reims, France.

出版信息

J Eur Acad Dermatol Venereol. 2013 Sep;27(9):1081-7. doi: 10.1111/j.1468-3083.2012.04652.x. Epub 2012 Jul 30.

DOI:10.1111/j.1468-3083.2012.04652.x

PMID:22845015

Abstract

BACKGROUND

Stage III melanoma represents a borderline situation regarding the potential curability of this potentially aggressive cancer and consequently, regional lymph node metastases (RLNM) are a major challenge for melanoma management.

OBJECTIVE

To describe the management of melanoma with RLNM as practised in France in 2008 and compare results with previous data from 2004, considering that new French recommendations were published in 2005.

METHODS

Retrospective population-based study in five regions of France totalling 8.3 million inhabitants, targeting all incident cases of RLNM diagnosed in 2008. Questionnaires were mailed to physicians to identify cases and collect data, with verification by cancer registries for cases diagnosed concomitantly with the primary tumour using sentinel lymph node biopsies (SLNB).

RESULTS

Data were collected for 101 patients in 2008, and compared to 89 cases treated in 2004. Palpation by a dermatologist was the most common circumstance of diagnosis of RLNM in 2008 (36%), followed by SLNB (29%), self-palpation by the patient (16%) and lymph node ultrasonography (6%), without significant modification from 2004. After lymphadenectomy an adjuvant therapy was proposed in 62% of cases, mainly consisting in high-dose interferon (HD-IFN) (80%). Overall, HD-IFN was proposed in 49% of cases, but effectively started in only 40% of cases after being proposed, and prematurely withdrawn in 28%, showing major changes as compared with 2004 (33%, 77% and 67%, respectively, P < 0.05). Adjuvant chemotherapy was not proposed to any patients in 2008, compared to 29% in 2004. Surveillance procedures included medical imaging less often in 2008 (76%) than in 2004 (92%) (P = 0.004), but more often included FDG-PET (23% vs. 12%, P = 0.09).

CONCLUSION

Overall, actual practice was in accordance with French recommendations. The main developments from 2004 to 2008 were the disappearance of adjuvant chemotherapies and a more accurate selection of patients for adjuvant interferon.

摘要

背景

III 期黑色素瘤代表了这种潜在侵袭性癌症潜在可治愈性的边缘情况，因此，区域淋巴结转移（RLNM）是黑色素瘤管理的主要挑战。

目的

描述 2008 年法国 RLNM 黑色素瘤的管理，并与 2004 年之前的数据进行比较，因为 2005 年发表了新的法国建议。

方法

对法国五个地区的 830 万居民进行了回顾性人群研究，共纳入 2008 年诊断的所有 RLNM 新发病例。向医生邮寄问卷以识别病例并收集数据，通过癌症登记处对同时使用前哨淋巴结活检（SLNB）诊断的原发性肿瘤病例进行验证。

结果

2008 年共收集了 101 例患者的数据，并与 2004 年的 89 例患者进行了比较。2008 年，皮肤科医生触诊是 RLNM 诊断最常见的情况（36%），其次是 SLNB（29%）、患者自我触诊（16%）和淋巴结超声检查（6%），与 2004 年相比没有明显变化。在淋巴结清扫术后，62%的病例提出了辅助治疗，主要是大剂量干扰素（HD-IFN）（80%）。总体而言，49%的病例提出了 HD-IFN，但在提出后仅有 40%的病例实际开始，28%的病例提前停药，与 2004 年相比有显著变化（分别为 33%、77%和 67%，P <0.05）。2008 年没有向任何患者提出辅助化疗，而 2004 年为 29%。2008 年，与 2004 年（92%）相比，（P=0.004），医疗成像监测的频率较低（76%），但更常使用 FDG-PET（23%比 12%，P=0.09）。