Division of Surgical Oncology, Department of Surgery, University of California at Davis, Sacramento, California.
J Surg Res. 2013 Nov;185(1):240-4. doi: 10.1016/j.jss.2013.05.090. Epub 2013 Jun 19.
Guidelines recommend that patients with melanoma metastatic to the sentinel lymph node (SLN) undergo a completion lymphadenectomy (CLND) of the affected lymph node basin. We have previously reported on decreased use of SLN biopsy among elderly patients. We hypothesized that elderly patients with SLN metastases would have lower rates of CLND relative to their younger counterparts.
The Surveillance, Epidemiology, and End Results database was queried for patients who underwent SLN biopsy for intermediate thickness cutaneous melanoma (Breslow thickness 1.01 mm-4.00 mm) from 2004 to 2008 and were found to have SLN metastasis. Patients were categorized according to age by decade. We then used multivariate logistic regression models to predict receipt of CLND. Additional covariates included sex, race/ethnicity, T stage, tumor histology, tumor location, and ulceration. The likelihood of receiving a CLND was reported as OR with 95% CI; significance was set at P ≤ 0.05.
Entry criteria were met by 765 patients. Of these, 548 (71.6%) patients underwent CLND. On multivariate analysis, patients in the age groups 70-79 y old (OR 0.39, CI 0.20-0.78; P = 0.007) and ≥ 80 y old (OR 0.27, CI 0.12-0.61; P = 0.001) were less likely to undergo CLND than the youngest age group (1-39 y old).
Elderly patients with SLN metastasis are less likely to receive CLND than their younger counterparts. A multi-center randomized clinical trial evaluating the potential survival benefit of CLND is ongoing. Further research to assess reasons why the elderly are less likely to receive CLND are needed.
指南建议，对于转移性至前哨淋巴结（SLN）的黑色素瘤患者，应进行受累淋巴结区域的完全淋巴结清扫术（CLND）。我们之前曾报告过老年患者 SLN 活检使用率降低的情况。我们假设，SLN 转移的老年患者接受 CLND 的比例相对低于年轻患者。
从 2004 年至 2008 年，我们在监测、流行病学和最终结果（SEER）数据库中查询了接受 SLN 活检的中厚度皮肤黑色素瘤（Breslow 厚度 1.01-4.00mm）患者，并发现有 SLN 转移。患者根据年龄每十年分为一组。然后，我们使用多变量逻辑回归模型来预测接受 CLND 的情况。其他协变量包括性别、种族/族裔、T 分期、肿瘤组织学、肿瘤位置和溃疡。CLND 接受率的可能性以 OR 和 95%CI 报告；P≤0.05 时为具有统计学意义。
符合纳入标准的患者共 765 例。其中，548 例（71.6%）患者接受了 CLND。多变量分析显示，70-79 岁（OR 0.39，CI 0.20-0.78；P=0.007）和≥80 岁（OR 0.27，CI 0.12-0.61；P=0.001）年龄组的患者接受 CLND 的可能性明显低于最年轻的年龄组（1-39 岁）。
与年轻患者相比，SLN 转移的老年患者接受 CLND 的可能性较小。一项评估 CLND 潜在生存获益的多中心随机临床试验正在进行中。需要进一步研究评估为什么老年人接受 CLND 的可能性较小的原因。
