前哨淋巴结切除术联合或不联合术前 SPECT/CT 与黑色素瘤转移淋巴结检测和无病生存的关系。

Association between sentinel lymph node excision with or without preoperative SPECT/CT and metastatic node detection and disease-free survival in melanoma.

机构信息

Department of Dermatology, Venerology, and Allergology, University of Essen-Duisburg, Essen, Germany.

出版信息

JAMA. 2012 Sep 12;308(10):1007-14. doi: 10.1001/2012.jama.11030.

DOI:10.1001/2012.jama.11030

PMID:22968889

Abstract

CONTEXT

Malignant melanoma has become an increasing interdisciplinary public health challenge worldwide. Sentinel lymph node excision (SLNE) is considered the most sensitive and specific staging test for the detection of micrometastatic melanoma in regional lymph nodes.

OBJECTIVE

To compare metastatic node detection and disease-free survival using single-photon emission computed tomography/computed tomography (SPECT/CT)-aided SLNE vs standard SLNE in patients with melanoma.

DESIGN, SETTING, AND PATIENTS: A prospective, computerized melanoma patient database at the University Hospital Essen, Skin Cancer Center, Essen, Germany, was used to identify a cohort of 464 patients eligible for SLNE between March 2003 and April 2011. A total of 403 patients with clinically negative lymph nodes, who underwent SLNE with or without preoperative SPECT/CT, qualified for subsequent analysis.

MAIN OUTCOME MEASURES

Metastatic node detection and disease-free survival.

RESULTS

Between March 2003 and October 2008, 254 patients underwent the standard SLNE technique. After November 2008, 149 patients underwent the SPECT/CT technique. Patients who did not receive SNLE in both intervals (46/300 [15.34%] for standard cohort vs 15/164 [9.15%] for SPECT/CT cohort; P = .06) did not differ in either age (difference, 69.20 years; 95% CI, 62.84-72.07 years; P = .38), tumor depth (difference, 2.90 mm; 95% CI, 2.87-4.54 mm; P = .54), or ulceration of the primary tumor (difference, -8.00%; 95% CI, -35.74% to 19.81%; P = .59). However, using SPECT/CT allowed SLNE in the head and neck area more frequently (2.0% for standard vs 23.5% for SPECT/CT; difference, 21.1%; 95% CI, 14.1%-28.2%; P < .001). In the SPECT/CT cohort, more sentinel lymph nodes per patient were detected than in the standard cohort (2.40 vs 1.87; 95% CI, 1.93-2.18; P < .001). The number of positive sentinel lymph nodes per patient was significantly higher in the SPECT/CT cohort than in the standard cohort (0.34 vs 0.21; 95% CI, 0.21-0.31; P = .04). The local relapse rate in the SPECT/CT cohort was lower than in the standard cohort (6.8% vs 23.8%, P = .03), which prolonged 4-year disease-free survival (93.9% vs 79.2%; P = .02).

CONCLUSION

Among patients with clinically lymph node-negative melanoma, the use of SPECT/CT-aided SLNE compared with SLNE alone was associated with a higher frequency of metastatic involvement and a higher rate of disease-free survival.

摘要

背景

恶性黑色素瘤已成为全球日益严重的跨学科公共卫生挑战。前哨淋巴结切除（SLNE）被认为是检测区域淋巴结微转移黑色素瘤最敏感和最特异的分期检测方法。

目的

比较单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）辅助 SLNE 与标准 SLNE 在黑色素瘤患者中的转移性淋巴结检测和无病生存率。

设计、地点和患者：德国埃森大学医院皮肤科癌症中心的一个前瞻性计算机化黑色素瘤患者数据库被用来确定 2003 年 3 月至 2011 年 4 月期间有资格进行 SLNE 的 464 例患者队列。共有 403 例临床淋巴结阴性患者接受了 SLNE 术，其中包括术前 SPECT/CT 检查或未行 SPECT/CT 检查，这些患者有资格进行后续分析。

主要观察指标

转移性淋巴结检测和无病生存率。

结果

2003 年 3 月至 2008 年 11 月期间，254 例患者接受了标准 SLNE 技术。2008 年 11 月后，149 例患者接受了 SPECT/CT 技术。在两个时间段均未接受 SNLE 的患者（标准队列中为 46/300 [15.34%]，SPECT/CT 队列中为 15/164 [9.15%]；P=.06）在年龄（差异，69.20 岁；95%CI，62.84-72.07 岁；P=.38）、肿瘤深度（差异，2.90 毫米；95%CI，2.87-4.54 毫米；P=.54）或原发性肿瘤溃疡（差异，-8.00%；95%CI，-35.74%至 19.81%；P=.59）方面无差异。然而，使用 SPECT/CT 可以更频繁地在头颈部进行 SLNE（标准组为 2.0%，SPECT/CT 组为 23.5%；差异，21.1%；95%CI，14.1%-28.2%；P <.001）。在 SPECT/CT 组中，每个患者检测到的前哨淋巴结比标准组多（2.40 比 1.87；95%CI，1.93-2.18；P <.001）。SPECT/CT 组每个患者的阳性前哨淋巴结数明显高于标准组（0.34 比 0.21；95%CI，0.21-0.31；P=.04）。SPECT/CT 组的局部复发率低于标准组（6.8%比 23.8%，P=.03），这延长了 4 年无病生存率（93.9%比 79.2%；P=.02）。