Dale Han, Jonathan S. Zager, Sanjana Iyengar, Mia Djulbegovic, Jaimie L. Weber, Suroosh S. Marzban, Vernon K. Sondak, and Jane L. Messina, Moffitt Cancer Center, Tampa; Eli Avisar, University of Miami, Miami, FL; Yu Shyr, Heidi Chen, and Lynne D. Berry, Vanderbilt University School of Medicine, Nashville, TN; John T. Vetto, Oregon Health and Science University, Portland, OR; Richard L. White, Carolinas Medical Center, Charlotte, NC; Barbara Pockaj, Mayo Clinic, Scottsdale; Robert Krouse, Southern Arizona Veterans Administration Health Care System, Tucson, AZ; Nicola Mozzillo, Istituto Nazionale dei Tumori-Fondazione Pascale, Naples, Italy; Kim James Charney, St Joseph Hospital, Orange; and Mohammed Kashani-Sabet and Stanley P. Leong, California Pacific Medical Center and Research Institute, San Francisco, CA.
J Clin Oncol. 2013 Dec 10;31(35):4387-93. doi: 10.1200/JCO.2013.50.1114. Epub 2013 Nov 4.
Indications for sentinel lymph node biopsy (SLNB) for thin melanoma are continually evolving. We present a large multi-institutional study to determine factors predictive of sentinel lymph node (SLN) metastasis in thin melanoma.
Retrospective review of the Sentinel Lymph Node Working Group database from 1994 to 2012 identified 1,250 patients who had an SLNB and thin melanomas (≤ 1 mm). Clinicopathologic characteristics were correlated with SLN status and outcome.
SLN metastases were detected in 65 (5.2%) of 1,250 patients. On univariable analysis, rates of Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, ulceration, and absence of regression differed significantly between positive and negative SLN groups (all P < .05). These four variables and mitotic rate were used in multivariable analysis, which demonstrated that Breslow thickness ≥ 0.75 mm (P = .03), Clark level ≥ IV (P = .05), and ulceration (P = .01) significantly predicted SLN metastasis with 6.3%, 7.0%, and 11.6% of the patients with these respective characteristics having SLN disease. Melanomas < 0.75 mm had positive SLN rates of < 5% regardless of Clark level and ulceration status. Median follow-up was 2.6 years. Melanoma-specific survival was significantly worse for patients with positive versus negative SLNs (P = .001).
Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, and ulceration significantly predict SLN disease in thin melanoma. Most SLN metastases (86.2%) occur in melanomas ≥ 0.75 mm, with 6.3% of these patients having SLN disease, whereas in melanomas < 0.75 mm, SLN metastasis rates are < 5%. By using a 5% metastasis risk threshold, SLNB is indicated for melanomas ≥ 0.75 mm, but further study is needed to define indications for SLNB in melanomas < 0.75 mm.
前哨淋巴结活检（SLNB）用于薄型黑色素瘤的适应证在不断发展。我们进行了一项大型多机构研究，以确定预测薄型黑色素瘤前哨淋巴结（SLN）转移的因素。
回顾性分析 1994 年至 2012 年 Sentinel Lymph Node Working Group 数据库，确定了 1250 例接受 SLNB 和薄型黑色素瘤（≤1mm）的患者。对临床病理特征与 SLN 状态和结果进行相关性分析。
1250 例患者中，有 65 例（5.2%）检测到 SLN 转移。单变量分析显示，Breslow 厚度≥0.75mm、Clark 分级≥IV 级、溃疡和无消退在 SLN 阳性和阴性组之间差异有统计学意义（均 P<.05）。这四个变量和有丝分裂率用于多变量分析，结果表明 Breslow 厚度≥0.75mm（P=0.03）、Clark 分级≥IV 级（P=0.05）和溃疡（P=0.01）显著预测 SLN 转移，分别有 6.3%、7.0%和 11.6%的患者具有这些特征，存在 SLN 疾病。Breslow 厚度<0.75mm 的黑色素瘤，无论 Clark 分级和溃疡状态如何，SLN 阳性率<5%。中位随访时间为 2.6 年。SLN 阳性患者的黑色素瘤特异性生存率明显低于 SLN 阴性患者（P=0.001）。
Breslow 厚度≥0.75mm、Clark 分级≥IV 级和溃疡显著预测薄型黑色素瘤的 SLN 疾病。大多数 SLN 转移（86.2%）发生在 Breslow 厚度≥0.75mm 的黑色素瘤中，其中 6.3%的患者存在 SLN 疾病，而 Breslow 厚度<0.75mm 的黑色素瘤，SLN 转移率<5%。使用 5%的转移风险阈值，SLNB 适用于 Breslow 厚度≥0.75mm 的黑色素瘤，但需要进一步研究来确定 Breslow 厚度<0.75mm 的黑色素瘤的 SLNB 适应证。
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