Sandro Pasquali, Andrea Maurichi, Nicola Mozzillo, Simone Mocellin, Giuseppe Macripò, Lorenzo Borgognoni, Nicola Solari, Dario Piazzalunga, Luigi Mascheroni, Giuseppe Giudice, Roberto Patuzzo, Corrado Caracò, Simone Ribero, Ugo Marone, Mario Santinami, Riccardo Rossi Carlo
Surgery Branch, Department of Surgery Oncology and Gastroenterology, University of Padova, Padua, Italy.
Ann Surg Oncol. 2015 Jul;22(7):2127-34. doi: 10.1245/s10434-014-4132-5. Epub 2014 Oct 15.
Lymph node ratio (LNR)-the number of metastatic lymph nodes (LNs) over the number of excised LNs after lymphadenectomy-is a prognostic factor for many solid tumors, but controversies still exist for skin melanoma. We investigated the prognostic relevance of LNR in melanoma patients and formulated a proposal for considering the LNR in the current American Joint Committee on Cancer (AJCC) N staging system.
Retrospective data of 2,526 melanoma patients with LN metastasis from nine Italian institutions were collected in a multicenter database. The prognostic value of the LNR (categorized as A, ≤0.1; B, 0.11-0.25; and C, >0.25) was assessed by multivariable survival analysis.
LNR was a significant independent prognostic factor for melanoma-specific survival (LNR B vs. A: hazard ratio [HR] 1.47, 95 % CI 1.16-1.87, p = 0.002; LNR C vs. A: HR 1.84, 95 % CI 1.29-2.61, p = 0.001). The LNR had prognostic value in patients with AJCC N1a (one positive LN after sentinel LN biopsy [SLNB], HR 2.33, 95 % CI 1.49-3.63, p < 0.001) and N2a (two to three positive LNs after SLNB, HR 1.62, 95 % CI 1.09-2.40, p = 0.016) substages, but not in those with N1b (one clinically positive LN, p = 0.765), N2b (two to three clinically positive LNs, p = 0.165), and N3 (≥ four positive LNs, p = 0.084) substages.
The LNR is a prognostic factor in melanoma patients with one (AJCC N1a) and two to three (AJCC N2a) positive LNs after SLNB. This easy-to-obtain parameter should be considered for the staging of melanoma patients with LN metastasis, along with the number of positive LNs.
淋巴结比率（LNR）——即淋巴结清扫术后转移淋巴结数量与切除淋巴结数量之比——是许多实体瘤的预后因素，但皮肤黑色素瘤方面仍存在争议。我们研究了LNR在黑色素瘤患者中的预后相关性，并就当前美国癌症联合委员会（AJCC）N分期系统中考虑LNR提出了一项建议。
从九个意大利机构收集了2526例有淋巴结转移的黑色素瘤患者的回顾性数据，并纳入一个多中心数据库。通过多变量生存分析评估LNR（分为A组，≤0.1；B组，0.11 - 0.25；C组，>0.25）的预后价值。
LNR是黑色素瘤特异性生存的显著独立预后因素（LNR B组与A组相比：风险比[HR] 1.47，95%置信区间1.16 - 1.87，p = 0.002；LNR C组与A组相比：HR 1.84，95%置信区间1.29 - 2.61，p = 0.001）。LNR在AJCC N1a期（前哨淋巴结活检[SLNB]后一个阳性淋巴结，HR 2.33，95%置信区间1.49 - 3.63，p < 0.001）和N2a期（SLNB后两到三个阳性淋巴结，HR 1.62，95%置信区间1.09 - 2.40，p = 0.016）的患者中有预后价值，但在N1b期（一个临床阳性淋巴结，p = 0.765）、N2b期（两到三个临床阳性淋巴结，p = 0.165）和N3期（≥四个阳性淋巴结，p = 0.084）的患者中没有。
LNR是SLNB后有一个（AJCC N1a）和两到三个（AJCC N2a）阳性淋巴结的黑色素瘤患者的预后因素。对于有淋巴结转移的黑色素瘤患者分期，应考虑这个易于获得的参数，以及阳性淋巴结数量。
