Koh Y X, Chok A Y, Zheng H, Xu S, Teo Melissa C C
Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Eur J Surg Oncol. 2014 Oct;40(10):1263-70. doi: 10.1016/j.ejso.2014.05.008. Epub 2014 Jun 5.
Patients with clinically palpable lymph node metastases to the groin are treated with groin dissection to control local disease and stage the malignancy. However, the extent of nodal dissection required to optimize survival rate is controversial.
To evaluate the approach to the extent of nodal dissection in advanced lower limb melanomas with clinically palpable inguinal nodes; to review survival outcomes based on the extent of nodal dissection and nodal disease.
A prospectively maintained database of 12 patients with lower limb melanoma was analyzed. Cloquet's node was assessed based on the frozen section result which guided the decision to proceed to iliac-obturator dissection. The correlation of the results of the Cloquet's nodes and radiological imaging to the final histological outcome of groin nodal dissection were compared.
The positive predictive value (PPV) of radiological imaging in identifying pelvic nodal disease was 60%. PPV of a positive or indeterminate frozen section result of Cloquet's node was 71.4%. Notably, all patients with a positive frozen section result for the Cloquet's node had positive pelvic nodal disease. Median DFS for all patients is 26 months (range 3-68 months) and the median OS for all patients is 28.5 months (range 5-68 months). Median DFS for node negative patients was 28 months (range 24-68 months). Median DFS for node positive patients was 20 months (range 3-36 months).
Cloquet's node was shown to be superior to radiological imaging and should be preferentially used to decide on the extent of nodal dissection.
临床上可触及腹股沟淋巴结转移的患者接受腹股沟淋巴结清扫术以控制局部疾病并对恶性肿瘤进行分期。然而，为优化生存率所需的淋巴结清扫范围存在争议。
评估对临床上可触及腹股沟淋巴结的晚期下肢黑色素瘤进行淋巴结清扫范围的方法；根据淋巴结清扫范围和淋巴结疾病回顾生存结果。
分析了一个前瞻性维护的12例下肢黑色素瘤患者的数据库。根据冰冻切片结果评估闭孔淋巴结，该结果指导了是否进行髂腹股沟淋巴结清扫的决策。比较了闭孔淋巴结结果和影像学检查结果与腹股沟淋巴结清扫最终组织学结果的相关性。
影像学检查在识别盆腔淋巴结疾病中的阳性预测值（PPV）为60%。闭孔淋巴结冰冻切片结果为阳性或不确定的PPV为71.4%。值得注意的是，所有闭孔淋巴结冰冻切片结果为阳性的患者均有盆腔淋巴结疾病。所有患者的中位无病生存期（DFS）为26个月（范围3 - 68个月），所有患者的中位总生存期（OS）为28.5个月（范围5 - 68个月）。淋巴结阴性患者的中位DFS为28个月（范围24 - 68个月）。淋巴结阳性患者的中位DFS为20个月（范围3 - 36个月）。
闭孔淋巴结显示优于影像学检查，应优先用于决定淋巴结清扫范围。
