Niebling M G, Wevers K P, Suurmeijer A J H, van Ginkel R J, Hoekstra Harald J
Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700, Groningen, The Netherlands.
Ann Surg Oncol. 2015 Jan;22(1):279-86. doi: 10.1245/s10434-014-3854-8. Epub 2014 Jul 10.
In order to define patients eligible for only a superficial groin dissection or a combined superficial and deep groin dissection, this study aimed to determine the incidence of deep lymph node metastases (LNM) in patients with melanoma metastasized to the groin, to identify patient and melanoma factors that predict deep nodal involvement, and to analyze the impact of deep nodal involvement on survival and recurrence.
Patients who underwent a combined superficial (inguinal) and deep (iliac and obturator) complete (CLND) or therapeutic lymph node dissection (TLND) of the groin between 1994 and 2012 were analyzed.
QueryDeep LNM were found in 8 of 62 CLND patients (13 %) and in 21 of 67 TLND patients (31 %). More than three superficial LNM was the only independent predictor for deep LNM in both CLND and TLND patients. The 5-year melanoma-specific survival (MSS) for CLND and TLND patients with deep LNM was 14.3 and 16.6 %, respectively, and was significantly worse (hazard ratio [HR] 3.39, 95 % CI 1.34-8.58, p = 0.010; and HR 2.01, 95 % CI 1.04-3.88, p = 0.039) compared with CLND and TLND patients without deep LNM (5-year MSS: 54.1 and 37.2 %, respectively). Distant recurrence was significantly associated with deep LNM in CLND patients (p = 0.032).
The present study showed that LNM in the deep area of the groin are fairly common in both CLND and TLND patients and significantly affect prognosis, especially in CLND patients. The number of superficial LNM is the only factor that was found to predict a finding of deep nodal metastases.
为了确定仅适合进行浅表腹股沟淋巴结清扫术或联合浅表和深部腹股沟淋巴结清扫术的患者，本研究旨在确定腹股沟转移黑色素瘤患者深部淋巴结转移（LNM）的发生率，识别预测深部淋巴结受累的患者和黑色素瘤相关因素，并分析深部淋巴结受累对生存和复发的影响。
分析了1994年至2012年间接受腹股沟浅表（腹股沟）和深部（髂骨和闭孔）完整（CLND）或治疗性淋巴结清扫术（TLND）的患者。
在62例CLND患者中有8例（13%）发现深部LNM，在67例TLND患者中有21例（31%）发现深部LNM。在CLND和TLND患者中，超过三个浅表LNM是深部LNM的唯一独立预测因素。CLND和TLND伴有深部LNM患者的5年黑色素瘤特异性生存率（MSS）分别为14.3%和16.6%，与无深部LNM的CLND和TLND患者相比（5年MSS分别为54.1%和37.2%）显著更差（风险比[HR] 3.39，95%置信区间1.34 - 8.58，p = 0.010；HR 2.01，95%置信区间1.04 - 3.88，p = 0.039）。在CLND患者中，远处复发与深部LNM显著相关（p = 0.032）。
本研究表明，在CLND和TLND患者中，腹股沟深部区域的LNM相当常见，并且显著影响预后，尤其是在CLND患者中。浅表LNM的数量是唯一被发现可预测深部淋巴结转移的因素。
