Division of Surgery, Breast Unit, Istituto di Ricovero e Cura a Carattere Scientifico "Azienda Ospedaliera Universitaria San Martino-IST", Genoa, Italy
Division of Surgical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico "Azienda Ospedaliera Universitaria San Martino-IST", Genoa, Italy.
Anticancer Res. 2014 Jun;34(6):3197-203.
From January 2003 to March 2010, a prospective study was undertaken at the National Cancer Research Institute of Genoa in 15 patients with melanoma who had local recurrence (LR) or a few (≤ 3) in-transit metastases and clinically-negative regional lymph nodes with the aim of defining: i) the feasibility of sentinel node re-staging (r-sN) of the regional nodal basin; ii) the prognostic value of sentinel node status, and iii) the potential benefit in terms of disease-free survival and overall survival in patients with an histologically-positive sentinel node undergoing therapeutic regional lymph node dissection. Preoperative lymphoscintigraphy was performed to identify the r-sN: the radiotracer was intra-dermally injected around the LR or in-transit metastasis. Moreover, 10 min prior to the operative procedure, 0.5 ml intradermal injection of Patent-Blue-V dye was given around each LR or in-transit metastasis site, so that r-sN identification was achieved by both visualization of the nodal blue dye staining and the information supplied by gamma-detection probe. At least one sentinel node was intra-operatively identified in each patient, and a tumor-positive r-sN was required in four out of fifteen patients. The interval between the diagnosis of primary melanoma and the onset of recurrence was longer, although not significantly, in patients with tumor-negative r-sN, a compared to tumor-positive r-sN (49 ± 47 months vs. 25 ± 19 months, p=0.342). There was a trend toward an improved 1-, 3-, and 5-year disease-free survival and overall survival in patients with tumor-negative r-sN a compared to tumor-positive r-sN. Hence, the r-sN proved to be a feasible and accurate staging procedure even in patients with a few localizations of LR or in-transit metastases (≤ 3). r-sN identified those with a more favorable prognosis, supporting an aggressive therapeutic approach in the natural history of their disease; moreover, an unnecessary regional lymph node dissection was safely avoided in 11 out of 15 73.3% patients because they had a tumor-negative r-sN.
从 2003 年 1 月至 2010 年 3 月，在热那亚国家癌症研究所对 15 名患有黑色素瘤的患者进行了一项前瞻性研究，这些患者有局部复发 (LR) 或少数（≤3）转移灶和临床阴性区域淋巴结，目的是确定：i）前哨淋巴结再分期 (r-sN) 的可行性；ii）前哨淋巴结状态的预后价值；iii）对于接受治疗性区域淋巴结清扫术的组织学阳性前哨淋巴结患者，在无病生存和总生存方面的潜在获益。术前进行淋巴闪烁显像以识别 r-sN：将放射性示踪剂皮内注射到 LR 或转移灶周围。此外，在手术前 10 分钟，在每个 LR 或转移灶周围皮内注射 0.5 毫升专利蓝 V 染料，通过淋巴结蓝染料染色的可视化和伽马探测探针提供的信息来实现 r-sN 识别。在每个患者中均在术中识别至少一个前哨淋巴结，在 15 名患者中有 4 名患者需要肿瘤阳性 r-sN。与肿瘤阳性 r-sN 相比，肿瘤阴性 r-sN 的患者中，原发性黑色素瘤和复发之间的间隔时间较长，尽管差异无统计学意义（49±47 个月比 25±19 个月，p=0.342）。与肿瘤阳性 r-sN 相比，肿瘤阴性 r-sN 的患者 1 年、3 年和 5 年无病生存率和总生存率均有改善的趋势。因此，r-sN 即使在少数局部 LR 或转移灶（≤3）的患者中也是一种可行且准确的分期方法。r-sN 识别出预后较好的患者，支持在疾病的自然史中采取积极的治疗方法；此外，由于 15 名患者中有 11 名患者 r-sN 为阴性，因此安全地避免了 11 名患者不必要的区域淋巴结清扫。
