Ribero Simone, Gualano Maria Rosaria, Osella-Abate Simona, Scaioli Giacomo, Bert Fabrizio, Sanlorenzo Martina, Balagna Elena, Fierro Maria Teresa, Macripò Giuseppe, Sapino Anna, Siliquini Roberta, Quaglino Pietro
Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy2Section of Dermatologic Surgery, Department of Oncology and Hematology, Città della Salute e della Scienza di Torino Hospital, Turin, Italy.
Department of Public Health, University of Turin, Turin, Italy.
JAMA Dermatol. 2015 Dec 1;151(12):1301-1307. doi: 10.1001/jamadermatol.2015.2235.
The prognostic significance of regression in primary melanoma has been debated for many years. There is no consensus regarding the need for sentinel lymph node (SLN) biopsy when regression is present within the primary tumor.
To review the evidence that regression may affect SLN status.
A systematic review was performed by searching in MEDLINE, Scopus, and the Cochrane Library from January 1, 1990, through June 2014.
All studies that reported an odds ratio (OR) or data on expected and observed cases of SLN positivity and histologic regression were included.
Primary random-effects meta-analyses were used to summarize ORs of SLN positivity and histologic regression. Heterogeneity was assessed using the χ2 test and I2 statistic. To assess the potential bias of small studies, we used funnel plots, the Begg rank correlation test, and the Egger weighted linear regression test. The methodologic quality of the studies was assessed according to the Strengthening of Reporting of Observational studies in Epidemiology (STROBE) checklist, and 2 different meta-analyses were performed based on those criteria.
Summary ORs of histologic regression of primary melanoma and SLN status.
Of the 1509 citations found in the search, 94 articles were reviewed, and 14 studies comprising 10 098 patients were included in the analysis. In the combined 14 studies, patients with regression had a lower likelihood to have SLN positivity (OR, 0.56; 95% CI, 0.41-0.77) than patients without regression. On the basis of study quality, we found that patients with regression enrolled in high-quality studies had a lower likelihood to have SLN positivity (OR, 0.48; 95% CI, 0.32-0.72) compared with results of low-quality studies (OR, 0.73; 95% CI, 0.53-1.00). Examination of the funnel plot did not provide evidence of publication bias.
The results of this analysis showed that the risk of SLN positivity was significantly lower in patients with histologic regression compared with those without. Regression may be used in these cases to make a selection of which patients should be the most appropriate for this procedure.
原发性黑色素瘤消退的预后意义多年来一直存在争议。对于原发性肿瘤内出现消退时是否需要进行前哨淋巴结（SLN）活检，目前尚无共识。
回顾关于消退可能影响SLN状态的证据。
通过检索1990年1月1日至2014年6月的MEDLINE、Scopus和Cochrane图书馆进行系统评价。
纳入所有报告优势比（OR）或前哨淋巴结阳性和组织学消退的预期及观察病例数据的研究。
采用原发性随机效应荟萃分析总结前哨淋巴结阳性和组织学消退的OR值。使用χ²检验和I²统计量评估异质性。为评估小型研究的潜在偏倚，我们使用了漏斗图、Begg秩相关检验和Egger加权线性回归检验。根据流行病学观察性研究报告强化（STROBE）清单评估研究的方法学质量，并基于这些标准进行了2项不同的荟萃分析。
原发性黑色素瘤组织学消退和前哨淋巴结状态的汇总OR值。
在检索到的1509篇文献中，审查了94篇文章，14项研究（共10098例患者）纳入分析。在这14项研究的合并分析中，有消退的患者前哨淋巴结阳性的可能性低于无消退的患者（OR = 0.56；95% CI：0.41 - 0.77）。基于研究质量，我们发现高质量研究中纳入的有消退的患者前哨淋巴结阳性的可能性低于低质量研究（OR = 0.48；95% CI：0.32 - 0.72）（低质量研究的OR = 0.73；95% CI：0.53 - 1.00）。漏斗图检查未提供发表偏倚的证据。
该分析结果表明，与无组织学消退的患者相比，有组织学消退的患者前哨淋巴结阳性风险显著更低。在这些病例中，消退可用于选择哪些患者最适合进行该手术。
