Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
J Surg Res. 2014 Apr;187(2):518-24. doi: 10.1016/j.jss.2013.10.037. Epub 2013 Oct 23.
Debate remains around the accuracy and prognostic implications of sentinel lymph node biopsy (SLNB) for melanoma arising in the head and neck (HN) areas because several analyses have shown discordances between clinically predicted lymphatic drainage pathways and those identified by lymphoscintigraphy. This study assesses the accuracy and prognostic value of SLNB in this critical anatomic region.
Retrospective review of a prospectively collected melanoma database identified 331 patients with HN melanomas from January 2000 to December 2012. Primary end points included SLNB result, time to recurrence, site of recurrence, and survival. Multivariate models were constructed for analyses.
A sentinel lymph node (SLN) was identified in all 331 patients. There were 59 patients with a positive SLN (17.8%) with a recurrence rate of 88.1% compared with 22.4% in SLN-negative patients (P < 0.0001). The 5-y overall survival was 91.2% for SLN-negative patients and 48.7% for SLN-positive patients (P < 0.0001). Patients with scalp melanoma had thicker lesions and an elevated risk of SLN positivity, recurrence, and death compared with those with other sites. Among the 272 SLN-negative patients, four patients developed regional nodal disease in the same basin and had undergone a previous SLNB procedure for a false-omission rate of 1.45%. Risks for false-negative SLN occurrences included thick and scalp melanomas. Multivariate analysis on prognostic factors affecting relapse-free survival showed positive SLNB status to be the most prognostic clinicopathologic predictor of recurrence (hazard ratio, 20.56; P < 0.0001).
SLNB for patients with HN melanomas is an accurate procedure and has prognostic value.
由于几项分析表明，临床预测的淋巴引流途径与淋巴闪烁显像识别的途径之间存在差异，因此对于发生在头颈部（HN）区域的黑色素瘤，前哨淋巴结活检（SLNB）的准确性和预后意义仍存在争议。本研究评估了 SLNB 在这一关键解剖区域的准确性和预后价值。
回顾性分析了 2000 年 1 月至 2012 年 12 月期间前瞻性收集的黑色素瘤数据库中的 331 例 HN 黑色素瘤患者。主要终点包括 SLNB 结果、复发时间、复发部位和生存情况。构建多变量模型进行分析。
所有 331 例患者均检出了前哨淋巴结（SLN）。59 例患者 SLN 阳性（17.8%），复发率为 88.1%，而 SLN 阴性患者的复发率为 22.4%（P<0.0001）。SLN 阴性患者的 5 年总生存率为 91.2%，SLN 阳性患者为 48.7%（P<0.0001）。与其他部位相比，头皮黑色素瘤患者的病变较厚，SLN 阳性、复发和死亡的风险更高。在 272 例 SLN 阴性患者中，4 例患者在同一区域发生了区域性淋巴结疾病，且之前进行了 SLNB 手术，假阴性率为 1.45%。SLN 假阴性的风险因素包括病变较厚和头皮黑色素瘤。对影响无复发生存的预后因素的多变量分析显示，SLNB 阳性是复发的最具预后意义的临床病理预测因素（危险比 20.56；P<0.0001）。
对于 HN 黑色素瘤患者，SLNB 是一种准确的方法，具有预后价值。
