Division of Surgical Oncology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
Eur J Surg Oncol. 2013 Feb;39(2):179-84. doi: 10.1016/j.ejso.2012.10.014. Epub 2012 Nov 6.
When completion lymph node dissection (CLND) is performed in sentinel node (SN)-positive melanoma patients, a positive non-sentinel node (NSN) is found in approximately 20% of them. Recently, Murali et al. proposed a new scoring system (non-sentinel node risk score, N-SNORE) to predict the risk of NSN positivity in SN-positive patients. The objectives of the current study were to identify factors predicting NSN positivity and to assess the validity of the N-SNORE in an independent patient cohort.
All SN-positive patients who underwent CLND at a single institution between 1995 and 2010 were analyzed. Characteristics of the patient, primary melanoma, and SN(s) were tested for association with NSN positivity. Missing values were reconstructed using multiple imputation to enable multivariable analysis.
CLND revealed positive NSNs in 30 (23%) of 130 SN-positive patients. Primary melanoma regression (p = 0.03) was independently associated with NSN positivity. After adjustment because of missing data on perinodal lymphatic invasion, N-SNORE proved to be a significant stratification model in our patient cohort (p = 0.003): 5.9% NSN positivity in the very low risk category and 75.0% NSN positivity in the very high risk category.
Presence of regression in the primary melanoma was independently associated with a higher risk of NSN positivity. The slightly modified N-SNORE scoring system provided useful stratification of the risk for NSN positivity. However, lack of perinodal lymphatic invasion data may have reduced its predictive value.
在 sentinel node（SN）阳性黑色素瘤患者中进行完全淋巴结清扫（CLND）时，约 20%的患者会发现非 sentinel node（NSN）阳性。最近，Murali 等人提出了一种新的评分系统（非 sentinel node 风险评分，N-SNORE）来预测 SN 阳性患者中 NSN 阳性的风险。本研究的目的是确定预测 NSN 阳性的因素，并在独立患者队列中评估 N-SNORE 的有效性。
分析了 1995 年至 2010 年在一家机构接受 CLND 的所有 SN 阳性患者。对患者、原发黑色素瘤和 SN（s）的特征进行了测试，以确定与 NSN 阳性的关系。使用多次插补法重建缺失值，以进行多变量分析。
CLND 显示 30 例（23%）SN 阳性患者的 NSN 阳性。原发黑色素瘤消退（p = 0.03）与 NSN 阳性独立相关。在调整了淋巴结周围淋巴管侵犯的缺失数据后，N-SNORE 在我们的患者队列中证明是一个显著的分层模型（p = 0.003）：非常低风险类别中 NSN 阳性率为 5.9%，非常高风险类别中 NSN 阳性率为 75.0%。
原发黑色素瘤的消退与 NSN 阳性的风险增加独立相关。经过轻微修改的 N-SNORE 评分系统为 NSN 阳性的风险提供了有用的分层。然而，缺乏淋巴结周围淋巴管侵犯的数据可能降低了其预测价值。
