Lima Sánchez Jaime, Sánchez Medina M, García Duque O, Fiúza Pérez M, Carreteri Hernández G, Fernández Palácios J
Department of Plastic, Reconstructive and Aesthetic Surgery, Universitary Hospital of Gran Canaria, Dr. Negrín, Las Palmas de Gran Canaria, Spain.
Indian J Plast Surg. 2013 Jan;46(1):92-7. doi: 10.4103/0970-0358.113717.
The aim of this study was to evaluate the results of sentinel lymph node biopsy (SLNB) in cutaneous melanoma at our institution.
128 patients with primary cutaneous melanoma who underwent SLNB between April, 2004, and August, 2010 were studied. Univariate and multivariate analysis was performed to explore the effect of variables on mortality and sentinel node status. Survival analysis was performed using the Kaplan-Meier approach.
Positive SLNB were detected in 35 (27.3%) of 128 cases. Mean Breslow depths were 3.7 mm for SLNB positive patients and 1.99 mm for SLNB negative patients. False negative rate was 1%. The recurrence rate was 40% for positive patients and 6.5% for negative patients (odds ratio 9.7 [confidence interval 95 % 3.3-28.1]). 33 patients (29%) had an ulcerated melanoma, 12 (10.5%) in the positive group and 21 (18.5%) in the negative group. The disease recurred in a 48.5% of patients with ulcerated melanoma, but only in a 2.5% of patients with non-ulcerated melanoma. Upon multivariate analysis, only Breslow thickness (P = 0.005) demonstrate statistically significance for SLNB status. Multivariate analysis for clinicopathologic predictors of death demonstrate statistically significance for Breslow thickness (P = 0.020), ulceration (P = 0.030) and sentinel node status (P = 0.020).
This study confirms that the status of the sentinel node is a strong independent prognostic factor with a higher risk of death and lower survival. Patients with ulcerated melanoma are more likely to develop recurrence, and also higher risk of death than patients with non-ulcerated melanoma.
本研究的目的是评估我院皮肤黑色素瘤前哨淋巴结活检（SLNB）的结果。
对2004年4月至2010年8月期间接受SLNB的128例原发性皮肤黑色素瘤患者进行研究。进行单因素和多因素分析以探讨变量对死亡率和前哨淋巴结状态的影响。采用Kaplan-Meier方法进行生存分析。
128例病例中有35例（27.3%）前哨淋巴结活检结果为阳性。前哨淋巴结活检阳性患者的平均Breslow深度为3.7mm，阴性患者为1.99mm。假阴性率为1%。阳性患者的复发率为40%，阴性患者为6.5%（优势比9.7[95%置信区间3.3 - 28.1]）。33例患者（29%）患有溃疡性黑色素瘤，阳性组12例（10.5%），阴性组21例（18.5%）。溃疡性黑色素瘤患者中有48.5%疾病复发，而非溃疡性黑色素瘤患者中仅2.5%复发。多因素分析显示，仅Breslow厚度（P = 0.005）对前哨淋巴结活检状态具有统计学意义。死亡的临床病理预测因素的多因素分析显示，Breslow厚度（P = 0.020）、溃疡形成（P = 0.030）和前哨淋巴结状态（P = 0.020）具有统计学意义。
本研究证实前哨淋巴结状态是一个强大的独立预后因素，死亡风险更高，生存率更低。与非溃疡性黑色素瘤患者相比，溃疡性黑色素瘤患者更易发生复发，死亡风险也更高。
