University of Louisville, Hiram C Polk Jr MD Department of Surgery, Louisville, KY, USA.
J Am Coll Surg. 2013 Jul;217(1):37-44; discussion 44-5. doi: 10.1016/j.jamcollsurg.2013.05.006.
Recent studies have suggested that sentinel lymph node (SLN) biopsy is of limited value in desmoplastic melanoma. This study was performed to compare the rate of positive SLN biopsy in the Surveillance, Epidemiology, and End Results (SEER) database with that of a multi-institutional clinical trial and to investigate relevant prognostic factors in desmoplastic melanoma.
Patients with desmoplastic melanoma ≥1.0 mm Breslow thickness, who underwent SLN biopsy in a multi-institutional prospective clinical trial, were combined with a single institution melanoma database (combined database) and compared with patients from the SEER database (1998 to 2009). Disease-free survival (DFS) and overall survival (OS) were summarized using Kaplan-Meier curves and compared using Cox proportional hazard models.
The rate of positive SLN in the combined database was 17.0% (8 of 47). By comparison, the rate of positive SLN in SEER was lower: 2.5% (15 of 594). On multivariable analysis, Breslow thickness ≥2.6 mm (hazard ratio 8.17, 95% CI 1.26 to 160.1; p = 0.0259) and an interaction between SLN status and ulceration (p = 0.0013) were independent risk factors for worse OS in the combined database; patients with ulceration and a positive SLN had significantly worse OS. In the combined database on multivariable analysis, SLN positivity (p = 0.0161) and ulceration (p = 0.0004) were independent risk factors for worse DFS.
The rate of positive SLN in desmoplastic melanoma may be higher than that reported in the SEER database. Sentinel lymph node biopsy may be considered as part of the comprehensive staging of desmoplastic melanoma ≥1.0 mm Breslow thickness.
最近的研究表明，前哨淋巴结（SLN）活检在硬纤维瘤样黑色素瘤中的价值有限。本研究旨在比较监测、流行病学和最终结果（SEER）数据库中的 SLN 活检阳性率与多机构临床试验的阳性率，并探讨硬纤维瘤样黑色素瘤的相关预后因素。
对接受多机构前瞻性临床试验 SLN 活检的 Breslow 厚度≥1.0 毫米的硬纤维瘤样黑色素瘤患者进行研究，将其与单一机构黑色素瘤数据库（联合数据库）相结合，并与 SEER 数据库（1998 年至 2009 年）中的患者进行比较。使用 Kaplan-Meier 曲线总结无病生存率（DFS）和总生存率（OS），并使用 Cox 比例风险模型进行比较。
联合数据库中 SLN 阳性率为 17.0%（47 例中有 8 例）。相比之下，SEER 中 SLN 阳性率较低：2.5%（594 例中有 15 例）。多变量分析显示，Breslow 厚度≥2.6 毫米（危险比 8.17，95%置信区间 1.26 至 160.1；p=0.0259）和 SLN 状态与溃疡之间的相互作用（p=0.0013）是联合数据库中 OS 较差的独立危险因素；有溃疡和 SLN 阳性的患者 OS 显著较差。在多变量分析中，SLN 阳性（p=0.0161）和溃疡（p=0.0004）是 DFS 较差的独立危险因素。
硬纤维瘤样黑色素瘤的 SLN 阳性率可能高于 SEER 数据库中的报告。SLN 活检可能被视为 Breslow 厚度≥1.0 毫米的硬纤维瘤样黑色素瘤综合分期的一部分。
