Yamamoto Maki, Fisher Kate J, Wong Joyce Y, Koscso Jonathan M, Konstantinovic Monique A, Govsyeyev Nicholas, Messina Jane L, Sarnaik Amod A, Cruse C Wayne, Gonzalez Ricardo J, Sondak Vernon K, Zager Jonathan S
Division of Surgical Oncology, Department of Surgery, University of California at Irvine Medical Center, Orange, California.
Cancer. 2015 May 15;121(10):1628-36. doi: 10.1002/cncr.29239. Epub 2015 Feb 11.
Sentinel lymph node biopsy (SLNB) is indicated for the staging of clinically lymph node-negative melanoma of intermediate thickness, but its use is controversial in patients with thick melanoma.
From 2002 to 2012, patients with melanoma measuring ≥4 mm in thickness were evaluated at a single institution. Associations between survival and clinicopathologic characteristics were explored.
Of 571 patients with melanomas measuring ≥4 mm in thickness and no distant metastases, the median age was 66 years and 401 patients (70.2%) were male. The median Breslow thickness was 6.2 mm; the predominant subtype was nodular (45.4%). SLNB was performed in 412 patients (72%) whereas 46 patients (8.1%) presented with clinically lymph node-positive disease and 113 patients (20%) did not undergo SLNB. A positive SLN was found in 161 of 412 patients (39.1%). For SLNB performed at the study institution, 14 patients with a negative SLNB developed disease recurrence in the mapped lymph node basin (false-negative rate, 12.3%). The median disease-specific survival (DSS), overall survival (OS), and recurrence-free survival (RFS) for the entire cohort were 62.1 months, 42.5 months, and 21.2 months, respectively. The DSS and OS for patients with a negative SLNB were 82.4 months and 53.4 months, respectively; 41.2 months and 34.7 months, respectively, for patients with positive SLNB; and 26.8 months and 22 months, respectively, for patients with clinically lymph node-positive disease (P<.0001). The median RFS was 32.4 months for patients who were SLNB negative, 14.3 months for patients who were SLNB positive, and 6.8 months for patients with clinically lymph node-positive disease (P<.0001).
With an acceptably low false-negative rate, patients with thick melanoma and a negative SLNB appear to have significantly prolonged RFS, DSS, and OS compared with those with a positive SLNB. Therefore, SLNB should be considered as indicated for patients with thick, clinically lymph node-negative melanoma.
前哨淋巴结活检（SLNB）适用于中度厚度的临床淋巴结阴性黑色素瘤的分期，但在厚黑色素瘤患者中的应用存在争议。
2002年至2012年，在单一机构对厚度≥4mm的黑色素瘤患者进行评估。探讨生存与临床病理特征之间的关联。
在571例厚度≥4mm且无远处转移的黑色素瘤患者中，中位年龄为66岁，401例（70.2%）为男性。中位Breslow厚度为6.2mm；主要亚型为结节型（45.4%）。412例患者（72%）接受了SLNB，而46例患者（8.1%）表现为临床淋巴结阳性疾病，113例患者（20%）未接受SLNB。412例患者中有161例（39.1%）前哨淋巴结阳性。对于在研究机构进行的SLNB，14例前哨淋巴结阴性的患者在标记的淋巴结区域出现疾病复发（假阴性率为12.3%）。整个队列的中位疾病特异性生存（DSS）、总生存（OS）和无复发生存（RFS）分别为62.1个月、42.5个月和21.2个月。前哨淋巴结阴性患者的DSS和OS分别为82.4个月和53.4个月；前哨淋巴结阳性患者分别为41.2个月和34.7个月；临床淋巴结阳性疾病患者分别为26.8个月和22个月（P<0.0001）。前哨淋巴结阴性患者的中位RFS为32.4个月，前哨淋巴结阳性患者为14.3个月，临床淋巴结阳性疾病患者为6.8个月（P<0.0001）。
假阴性率可接受地低，厚黑色素瘤且前哨淋巴结阴性的患者与前哨淋巴结阳性的患者相比，RFS、DSS和OS似乎显著延长。因此，对于厚的、临床淋巴结阴性的黑色素瘤患者，应考虑按指征进行SLNB。
