前哨淋巴结的三重标记物聚合酶链反应检测作为黑色素瘤的预后因素

Triple-marker PCR assay of sentinel lymph node as a prognostic factor in melanoma.

作者信息

Ito T, Wada M, Nagae K, Nakano-Nakamura M, Nakahara T, Hagihara A, Furue M, Uchi H

机构信息

Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

出版信息

J Eur Acad Dermatol Venereol. 2015 May;29(5):912-8. doi: 10.1111/jdv.12722. Epub 2014 Sep 8.

DOI:10.1111/jdv.12722

PMID:25199412

Abstract

BACKGROUND

Metastasis of sentinel lymph node (SLN) is generally evaluated on histopathological examination and controversy still exists over the usefulness of PCR assay of SLN.

OBJECTIVE

To investigate the prognostic value of triple-marker PCR assay of SLN.

METHODS

A total of 165 patients with primary cutaneous melanoma who underwent SLN biopsy were included. Clinical and histopathological data were retrieved from each patient's file and triple-marker PCR assay (tyrosinase, GP-100 and MART-1) was performed on the SLN as well as routine histopathological evaluation. PCR positivity was defined as the expression of all three PCR markers. To evaluate melanoma-specific survival (MSS) and disease-free survival (DFS), we used the Kaplan-Meier method and the log-rank test. Multivariate analyses using the Cox proportional hazards regression model were also performed.

RESULTS

Sentinel lymph nodes were identified in all 165 patients: 61 patients (37.0%) were male and 104 (63.0%) were female, with a mean age of 60.2 years. Of the 165 melanomas, 81 (49.1%) were acral lentiginous melanomas. Compared with the patients with PCR positivity (1-2 markers) or PCR negativity, patients with PCR positivity (3 markers) had significantly poor MSS (5-year survival rate, 58.7% vs. 84.4%; P < 0.0001) and DFS (5-year survival rate, 25.0% vs. 83.9%; P < 0.0001), with median follow-up of 42 months for MSS and 38 months for DFS. These survival rates of patients with PCR positivity (3 markers) were lower than those of patients with histopathologically positive SLN. In multivariate analysis, PCR positivity (3 markers) was an independent prognostic factor for both MSS (hazard ratio [HR], 2.81; 95% confidence interval [CI], 1.07-7.33; P = 0.035) and DFS (HR, 2.48; 95% CI, 1.08-5.69; P = 0.032).

CONCLUSIONS

The expression of three PCR markers was a significant prognostic factor for both MSS and DFS and might be closely correlated to a dismal prognosis.

摘要

背景

前哨淋巴结（SLN）转移一般通过组织病理学检查进行评估，而SLN的聚合酶链反应（PCR）检测的实用性仍存在争议。

目的

探讨SLN的三联标志物PCR检测的预后价值。

方法

共纳入165例行SLN活检的原发性皮肤黑色素瘤患者。从每位患者的病历中获取临床和组织病理学数据，并对SLN进行三联标志物PCR检测（酪氨酸酶、糖蛋白100和黑色素瘤抗原识别分子1）以及常规组织病理学评估。PCR阳性定义为所有三种PCR标志物均表达。为评估黑色素瘤特异性生存（MSS）和无病生存（DFS），我们采用Kaplan-Meier法和对数秩检验。还使用Cox比例风险回归模型进行多变量分析。

结果

165例患者均成功识别出前哨淋巴结：男性61例（37.0%），女性104例（63.0%），平均年龄60.2岁。165例黑色素瘤中，81例（49.1%）为肢端雀斑样黑色素瘤。与PCR阳性（1 - 2种标志物）或PCR阴性的患者相比，PCR阳性（3种标志物）的患者MSS显著较差（5年生存率分别为58.7%和84.4%；P < 0.0001），DFS也显著较差（5年生存率分别为25.0%和83.9%；P < 0.0001），MSS的中位随访时间为42个月，DFS为38个月。PCR阳性（3种标志物）患者的这些生存率低于组织病理学检查SLN阳性的患者。在多变量分析中，PCR阳性（3种标志物）是MSS（风险比[HR]，2.81；95%置信区间[CI]，1.07 - 7.33；P = 0.035）和DFS（HR，2.48；95% CI，1.08 - 5.69；P = 0.032）的独立预后因素。