Center for Melanoma Research & Treatment, California Pacific Medical Center, San Francisco, CA, USA.
Ann Surg Oncol. 2013 Sep;20(9):3089-97. doi: 10.1245/s10434-013-2977-7. Epub 2013 May 7.
Previous studies showed conflicting and inconsistent results regarding the effect of anatomic location of the melanoma on sentinel lymph node (SLN) positivity and/or survival. This study was conducted to evaluate and compare the effect of the anatomic locations of primary melanoma on long-term clinical outcomes.
All consecutive cutaneous melanoma patients (n=2,079) who underwent selective SLN dissection (SLND) from 1993 to 2009 in a single academic tertiary-care medical center were included. SLN positive rate, disease-free survival (DFS), and overall survival (OS) were determined. Kaplan-Meier survival, univariate, and multivariate analyses were performed to determine predictive factors for SLN status, DFS, and OS.
Head and neck melanoma (HNM) had the lowest SLN-positive rate at 10.8% (16.8% for extremity and 19.3% for trunk; P=0.002) but had the worst 5-year DFS (P<0.0001) and 5-year OS (P<0.0001) compared with other sites. Tumor thickness (P<0.001), ulceration (P<0.001), HNM location (P=0.001), mitotic rate (P<0.001), and decreasing age (P<0.001) were independent predictive factors for SLN-positivity. HNM with T3 or T4 thickness had significantly lower SLN positive rate compared with other locations (P≤0.05). Also, on multivariate analysis, HNM location versus other anatomic sites was independently predictive of decreased DFS and OS (P<0.001). By Kaplan-Meier analysis, HNM was associated significantly with the worst DFS and OS.
Primary melanoma anatomic location is an independent predictor of SLN status and survival. Although HNM has a decreased SLN-positivity rate, it shows a significantly increased risk of recurrence and death as compared with other sites.
先前的研究对于黑色素瘤的解剖位置对前哨淋巴结（SLN）阳性率和/或生存率的影响存在相互矛盾和不一致的结果。本研究旨在评估和比较原发性黑色素瘤的解剖位置对长期临床结局的影响。
纳入了 1993 年至 2009 年期间在一家学术性三级医疗中心接受选择性 SLN 解剖（SLND）的所有连续皮肤黑色素瘤患者（n=2079）。确定 SLN 阳性率、无病生存率（DFS）和总生存率（OS）。进行 Kaplan-Meier 生存分析、单变量和多变量分析，以确定 SLN 状态、DFS 和 OS 的预测因素。
头颈部黑色素瘤（HNM）的 SLN 阳性率最低，为 10.8%（四肢为 16.8%，躯干为 19.3%；P=0.002），但与其他部位相比，5 年 DFS（P<0.0001）和 5 年 OS（P<0.0001）最差。肿瘤厚度（P<0.001）、溃疡（P<0.001）、HNM 位置（P=0.001）、有丝分裂率（P<0.001）和年龄降低（P<0.001）是 SLN 阳性的独立预测因素。厚度为 T3 或 T4 的 HNM 与其他部位相比，SLN 阳性率显著降低（P≤0.05）。此外，多变量分析显示，HNM 位置与其他解剖部位相比，是 DFS 和 OS 降低的独立预测因素（P<0.001）。通过 Kaplan-Meier 分析，HNM 与最差的 DFS 和 OS 显著相关。
原发性黑色素瘤的解剖位置是 SLN 状态和生存的独立预测因素。尽管 HNM 的 SLN 阳性率较低，但与其他部位相比，其复发和死亡风险显著增加。
