Sabel Michael S, Kozminski David, Griffith Kent, Chang Alfred E, Johnson Timothy M, Wong Sandra
Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA,
Ann Surg Oncol. 2015 Jul;22(7):2112-9. doi: 10.1245/s10434-015-4539-7. Epub 2015 Apr 3.
While SLN biopsy is recommended for melanoma ≥1 mm in depth, its use among the elderly population is more controversial. We reviewed our experience at the University of Michigan with melanoma patients ≥75 years of age.
A total of 952 melanoma patients ≥75 years of age from 1996 to 2011 were identified from our institutional review board-approved database. In addition to clinicopathologic features and outcome data, comorbidity data were collected to calculate the Charlson comorbidity index (CCI). Univariate and multivariate Cox regression analysis was performed to characterize predictors of outcome. Kaplan-Meier analysis was used to generate survival curves.
Among 553 clinically node-negative patients with melanoma ≥1 mm in Breslow thickness, 213 had wide excision alone, whereas 340 had excision and SLN biopsy, with 83 (24 %) having a positive SLN. SLN biopsy was less likely with older age (p < 0.0001) and H&N location (p = 0.007), but not CCI. SLN involvement was associated with female gender [odds ratio (OR) 2.15, p = 0.009], Breslow thickness [OR 1.23/mm increase, p = 0.004], and satellitosis (OR 4.43, p = 0.004). Distant disease-specific survival was negatively associated with male gender (OR 1.5, p = 0.007), increasing age (OR 1.05/year, p < 0.001), increasing Breslow thickness (OR 1.07/year, p = 0.013), ulceration (OR 1.51, p = 0.004), a positive SLN (OR 2.61, p < 0.001), and not having a SLN biopsy (OR 1.72, p < 0.001). CCI did not predict worse disease-free or melanoma-specific survival.
WLE and SLN biopsy was not only strongly prognostic, but compared with WLE alone was associated with improved outcome, even after factoring for age and comorbidities. If otherwise healthy, SLN biopsy should be strongly considered for this population.
虽然对于厚度≥1mm的黑色素瘤推荐进行前哨淋巴结活检，但在老年人群中的应用更具争议性。我们回顾了密歇根大学对年龄≥75岁的黑色素瘤患者的治疗经验。
从我们机构审查委员会批准的数据库中识别出1996年至2011年间共952例年龄≥75岁的黑色素瘤患者。除了临床病理特征和结局数据外，还收集了合并症数据以计算查尔森合并症指数（CCI）。进行单因素和多因素Cox回归分析以确定结局的预测因素。采用Kaplan-Meier分析生成生存曲线。
在553例临床淋巴结阴性、Breslow厚度≥1mm的黑色素瘤患者中，213例仅行广泛切除，而340例行切除及前哨淋巴结活检，其中83例（24%）前哨淋巴结阳性。年龄较大（p<0.0001）和头颈部部位（p=0.007）的患者进行前哨淋巴结活检的可能性较小，但CCI并非如此。前哨淋巴结受累与女性性别[比值比（OR）2.15，p=0.009]、Breslow厚度[OR每增加1mm为1.23，p=0.004]和卫星灶（OR 4.43，p=0.004）相关。远处疾病特异性生存与男性性别（OR 1.5，p=0.007）、年龄增加（OR每年1.05，p<0.001）、Breslow厚度增加（OR每年1.07，p=0.013）、溃疡（OR 1.51，p=0.004）、前哨淋巴结阳性（OR 2.61，p<0.001）以及未进行前哨淋巴结活检（OR 1.72，p<0.001）呈负相关。CCI并不能预测更差的无病生存或黑色素瘤特异性生存。
广泛局部切除和前哨淋巴结活检不仅具有很强的预后价值，而且与单纯广泛局部切除相比，即使在考虑年龄和合并症因素后，也与更好的结局相关。如果其他方面健康，对于该人群应强烈考虑进行前哨淋巴结活检。
