Department of Surgery, University of Colorado Denver, Aurora, CO 80045, USA.
JAMA Surg. 2013 May;148(5):456-61. doi: 10.1001/jamasurg.2013.1335.
To analyze the predictors and patterns of recurrence of melanoma in patients with a negative sentinel lymph node biopsy result.
Retrospective chart review of a prospectively created database of patients with cutaneous melanoma. SETTING Tertiary university hospital.
A total of 515 patients with melanoma underwent a sentinel lymph node biopsy without evidence of metastatic disease between 1996 and 2008.
Time to recurrence and overall survival.
Of 515 patients, 83 (16%) had a recurrence of melanoma at a median of 23 months during a median follow-up of 61 months (range, 1-154 months). Of these 83 patients, 21 had melanoma that metastasized in the studied nodal basin for an in-basin false-negative rate of 4.0%. Patients with recurrence had deeper primary lesions (mean thickness, 2.7 vs 1.8 mm; P < .01) that were more likely to be ulcerated (32.5% vs 13.5%; P < .001) than those without recurrence. The primary melanoma of patients with recurrence was more likely to be located in the head and neck region compared with all other locations combined (31.8% vs 11.7%; P < .001). Median survival following a recurrence was 21 months (range, 1-106 months). Favorable characteristics associated with lower risk of recurrence included younger age at diagnosis (mean, 49 vs 57 years) and female sex (9% vs 21% for males; P < .001).
Overall, recurrence of melanoma (16%) after a negative sentinel lymph node biopsy result was similar to that in previously reported studies with an in-basin false-negative rate of 4.0%. Lesions of the head and neck, the presence of ulceration, increasing Breslow thickness, older age, and male sex are associated with increased risk of recurrence, despite a negative sentinel lymph node biopsy result.
分析阴性前哨淋巴结活检结果患者黑色素瘤复发的预测因素和模式。
对 1996 年至 2008 年间接受前哨淋巴结活检且无转移性疾病证据的皮肤黑色素瘤患者的前瞻性创建数据库进行回顾性图表审查。
三级大学医院。
共有 515 例黑色素瘤患者接受了前哨淋巴结活检，在中位随访 61 个月（范围为 1-154 个月）期间，83 例（16%）患者出现黑色素瘤复发，中位数时间为 23 个月。在这 83 例患者中，有 21 例患者的黑色素瘤在研究的淋巴结区内转移，淋巴结内假阴性率为 4.0%。复发患者的原发肿瘤更深（平均厚度为 2.7 毫米比 1.8 毫米；P <.01），且更有可能发生溃疡（32.5%比 13.5%；P <.001）。与无复发者相比，复发患者的原发性黑色素瘤更可能位于头颈部（31.8%比所有其他部位的总和 11.7%；P <.001）。复发后中位生存时间为 21 个月（范围为 1-106 个月）。与较低的复发风险相关的有利特征包括诊断时年龄较小（平均年龄为 49 岁比 57 岁）和女性（9%比男性 21%；P <.001）。
总体而言，尽管前哨淋巴结活检结果为阴性，但黑色素瘤（16%）的复发与之前报道的研究相似，淋巴结内假阴性率为 4.0%。头颈部病变、溃疡存在、Breslow 厚度增加、年龄较大和男性与阴性前哨淋巴结活检结果相关的复发风险增加。
