The Buncke Clinic, Plastic Surgery, California Pacific Medical Center, San Francisco, CA 94115, USA.
Melanoma Res. 2012 Oct;22(5):386-91. doi: 10.1097/CMR.0b013e32835861f6.
For primary melanoma, there is a delay between the initial skin biopsy and sentinel lymph node dissection, which may cause anxiety for the patient. The consequences of this delay on disease progression are unknown. The goal of this study was to determine whether delay time for sentinel node dissection from the initial cutaneous melanoma biopsy affects patient outcomes. A retrospective analysis of 492 patients with melanoma who underwent a sentinel node dissection between 1993 and 1999 was carried out. The endpoints assessed were sentinel node tumor status, recurrence, and mortality. Time to sentinel node dissection was compared between patients with positive and negative sentinel nodes. Long-term survival and recurrence were evaluated in relation to the time between the cutaneous biopsy and the sentinel node dissection (delay time), comparing less than 40 days with at least 40 days. In total, 15.9% of patients had positive sentinel nodes. The median follow-up was 11.7 years. Positive sentinel node patients had a median delay of 35 days between the primary melanoma biopsy and the sentinel node dissection compared with 41 days for negative sentinel node patients (P=0.5). Kaplan-Meier survival curves showed that a delay time of less than 40 days versus at least 40 days was not related to recurrence of melanoma (log-rank P=0.13) or overall survival (log-rank P=0.14). On multivariate analysis of age, thickness, ulceration, and sentinel node status, there was no difference in disease-free survival (P=0.58) or overall survival (P=0.53) between the less than 40 days and the at least 40 days groups. A modest delay in sentinel node dissection from the initial melanoma biopsy does not adversely affect sentinel node status, recurrence, nor survival.
对于原发性黑色素瘤，从初次皮肤活检到前哨淋巴结清扫之间存在时间延迟，这可能会使患者感到焦虑。目前尚不清楚这种延迟对疾病进展的影响。本研究的目的是确定从初始皮肤黑色素瘤活检到前哨淋巴结清扫的延迟时间是否会影响患者的预后。我们对 1993 年至 1999 年间接受前哨淋巴结清扫的 492 例黑色素瘤患者进行了回顾性分析。评估的终点包括前哨淋巴结肿瘤状态、复发和死亡率。比较了前哨淋巴结阳性和阴性患者的前哨淋巴结清扫时间。根据皮肤活检与前哨淋巴结清扫之间的时间（延迟时间）评估长期生存和复发情况，将小于 40 天与至少 40 天进行比较。总共有 15.9%的患者前哨淋巴结阳性。中位随访时间为 11.7 年。与前哨淋巴结阴性患者（41 天）相比，前哨淋巴结阳性患者初次黑色素瘤活检与前哨淋巴结清扫之间的中位延迟时间为 35 天（P=0.5）。Kaplan-Meier 生存曲线显示，小于 40 天与至少 40 天的延迟时间与黑色素瘤的复发（对数秩检验 P=0.13）或总生存（对数秩检验 P=0.14）无关。在对年龄、厚度、溃疡和前哨淋巴结状态进行多变量分析后，在无病生存（P=0.58）或总生存（P=0.53）方面，小于 40 天组和至少 40 天组之间无差异。从前哨淋巴结活检到初始黑色素瘤活检的适度延迟不会对前哨淋巴结状态、复发或生存产生不利影响。
