Wu Chiao-En, Hsieh Chia-Hsun, Chang Cheng-Jen, Yeh Jiun-Ting, Kuo Tseng-Tong, Yang Chih-Hsun, Lo Yung-Feng, Lin Kun-Ju, Lin Yung-Chang, Chang John Wen-Cheng
Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
J Formos Med Assoc. 2015 May;114(5):415-21. doi: 10.1016/j.jfma.2013.06.018. Epub 2013 Aug 19.
BACKGROUND/PURPOSE: Sentinel lymph node biopsy (SLNB) is a standard procedure in the management of clinically node-negative melanoma. However, few studies have been performed on SLNB in Asia, which is an acral melanoma-prevalent area. This study evaluated the clinicopathologic prognostic factors of disease-free survival (DFS) and overall survival (OS) in Taiwanese patients with cutaneous melanoma who received wide excision and SLNB. The prognosis of patients with false-negative (FN) SLNB was also evaluated.
Malignant melanoma cases were reviewed for 518 patients who were treated between January 2000 and December 2011. Of these patients, 127 patients with node-negative cutaneous melanoma who received successful SLNB were eligible for inclusion in the study.
The SLNB-positive rate was 34.6%. The median DFS was 51.5 months, and the median OS was 90.9 months at the median follow-up of 36.6 months. Multivariate analysis revealed that patients whose melanoma had a Breslow thickness greater than 2 mm had a significantly shorter DFS than patients whose melanoma had a Breslow thickness of 2 mm or less [hazard ratio (HR), 3.421; p = 0.005]. Independent prognostic factors of OS were a Breslow thickness greater than 2 mm (HR, 4.435; p = 0.002); nonacral melanoma (HR, 3.048; p = 0.001); and an age older than 65 years (HR, 2.819; p = 0.036). During the follow-up period, 13 of 83 SLN-negative patients developed a regional nodal recurrence. The SLNB failure rate was 15.7% and the FN rate was 22.8%. Compared to patients with a true-positive SLNB, patients with FN SLNB had a significantly shorter DFS (p = 0.001) but no significant difference in OS (p = 0.262).
Except for the pathologic subtypes, prognostic factors in Taiwan are similar to those used in other melanoma-prevalent countries. Identifying and closely monitoring patients at risk of nodal recurrence after a negative SLNB is important.
背景/目的：前哨淋巴结活检（SLNB）是临床淋巴结阴性黑色素瘤治疗中的标准程序。然而，在亚洲这个肢端黑色素瘤高发地区，针对SLNB的研究较少。本研究评估了接受广泛切除和SLNB的台湾皮肤黑色素瘤患者无病生存期（DFS）和总生存期（OS）的临床病理预后因素。还评估了前哨淋巴结活检假阴性（FN）患者的预后。
回顾了2000年1月至2011年12月期间接受治疗的518例恶性黑色素瘤病例。其中，127例接受成功前哨淋巴结活检的淋巴结阴性皮肤黑色素瘤患者符合纳入本研究的条件。
前哨淋巴结活检阳性率为34.6%。在中位随访36.6个月时，中位DFS为51.5个月，中位OS为90.9个月。多因素分析显示，黑色素瘤Breslow厚度大于2mm的患者DFS显著短于Breslow厚度为2mm或更小的患者[风险比（HR），3.421；p = 0.005]。OS的独立预后因素为Breslow厚度大于2mm（HR，4.435；p = 0.002）；非肢端黑色素瘤（HR，3.048；p = 0.001）；以及年龄大于65岁（HR，2.819；p = 0.036）。在随访期间，83例前哨淋巴结阴性患者中有13例发生区域淋巴结复发。前哨淋巴结活检失败率为15.7%，FN率为22.8%。与前哨淋巴结活检真阳性患者相比，FN患者的DFS显著缩短（p = 0.001），但OS无显著差异（p = 0.262）。
除病理亚型外，台湾的预后因素与其他黑色素瘤高发国家相似。识别并密切监测前哨淋巴结活检阴性后有淋巴结复发风险的患者很重要。
