Tejera-Vaquerizo A, Martín-Cuevas P, Gallego E, Herrera-Acosta E, Traves V, Herrera-Ceballos E, Nagore E
Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga, España.
Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga, España.
Actas Dermosifiliogr. 2015 Apr;106(3):208-18. doi: 10.1016/j.ad.2014.10.012. Epub 2015 Jan 20.
The main aim of this study was to identify predictors of sentinel lymph node (SN) metastasis in cutaneous melanoma.
This was a retrospective cohort study of 818 patients in 2 tertiary-level hospitals. The primary outcome variable was SN involvement. Independent predictors were identified using multiple logistic regression and a classification and regression tree (CART) analysis.
Ulceration, tumor thickness, and a high mitotic rate (≥6 mitoses/mm(2)) were independently associated with SN metastasis in the multiple regression analysis. The most important predictor in the CART analysis was Breslow thickness. Absence of an inflammatory infiltrate, patient age, and tumor location were predictive of SN metastasis in patients with tumors thicker than 2mm. In the case of thinner melanomas, the predictors were mitotic rate (>6 mitoses/mm(2)), presence of ulceration, and tumor thickness. Patient age, mitotic rate, and tumor thickness and location were predictive of survival.
A high mitotic rate predicts a higher risk of SN involvement and worse survival. CART analysis improves the prediction of regional metastasis, resulting in better clinical management of melanoma patients. It may also help select suitable candidates for inclusion in clinical trials.
本研究的主要目的是确定皮肤黑色素瘤前哨淋巴结（SN）转移的预测因素。
这是一项对两家三级医院818例患者进行的回顾性队列研究。主要结局变量是前哨淋巴结受累情况。使用多元逻辑回归和分类回归树（CART）分析确定独立预测因素。
在多元回归分析中，溃疡、肿瘤厚度和高有丝分裂率（≥6个有丝分裂/平方毫米）与前哨淋巴结转移独立相关。CART分析中最重要的预测因素是 Breslow 厚度。对于肿瘤厚度超过2mm的患者，无炎症浸润、患者年龄和肿瘤部位可预测前哨淋巴结转移。对于较薄的黑色素瘤，预测因素是有丝分裂率（>6个有丝分裂/平方毫米）、溃疡的存在和肿瘤厚度。患者年龄、有丝分裂率、肿瘤厚度和部位可预测生存率。
高有丝分裂率预示前哨淋巴结受累风险更高且生存率更差。CART分析改善了区域转移的预测，从而对黑色素瘤患者进行更好的临床管理。它还可能有助于选择适合纳入临床试验的患者。
