Dunne Jonathan A, Wormald Justin C R, Steele Jessica, Woods Elizabeth, Odili Joy, Powell Barry W E M
Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, United Kingdom.
Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, United Kingdom.
J Plast Reconstr Aesthet Surg. 2017 Feb;70(2):274-280. doi: 10.1016/j.bjps.2016.11.003. Epub 2016 Nov 16.
Desmoplastic melanoma (DM) is an uncommon malignancy associated with a high local recurrence rate. The aim of this systematic review was to determine the positivity rate of sentinel lymph node biopsy (SLNB) in patients with DM. The secondary outcome was to establish if SLNB is warranted for both pure DM (PDM) and mixed DM (MDM).
A full systematic literature review of SLNB in DM was performed by two authors in January 2016. Ovid MEDLINE, Ovid EMBASE and the Cochrane Central Register of Controlled Trials were searched.
Sixteen studies involving 1519 patients having SLNB in DM were included, of which 99 patients had positive SLNB (6.5%). Two articles reported a significantly reduced disease-free survival (DFS) with positive SLNB and three published a reduced melanoma-specific survival (MSS). Six studies compared SLNB in MDM and PDM. Of the 275 patients, 38 (13.8%) had a positive SLNB in MDM compared to 17 of 313 patients (5.4%) with positive SLNB in PDM.
Rates of positive SLNB in DM are reduced compared to other variants of melanoma; however, nodal status may still predict DFS and MSS. MDM is associated with a higher rate of micro-metastases to regional lymph nodes than PDM, and DFS and MSS may be lesser in MDM than in PDM. We would recommend the consideration of SLNB in MDM. However, with such low rates of positive SLNB in PDM, and in the absence of high-risk features to stratify patients, we would not recommend SLNB in PDM.
促纤维增生性黑色素瘤（DM）是一种罕见的恶性肿瘤，局部复发率高。本系统评价的目的是确定DM患者前哨淋巴结活检（SLNB）的阳性率。次要结果是确定SLNB对单纯性DM（PDM）和混合性DM（MDM）是否均适用。
2016年1月，两位作者对DM中SLNB进行了全面的系统文献综述。检索了Ovid MEDLINE、Ovid EMBASE和Cochrane对照试验中央注册库。
纳入了16项研究，共1519例DM患者接受了SLNB，其中99例SLNB阳性（6.5%）。两篇文章报道SLNB阳性患者的无病生存期（DFS）显著降低，三篇文章报道黑色素瘤特异性生存期（MSS）降低。六项研究比较了MDM和PDM中的SLNB。在275例患者中，MDM中有38例（13.8%）SLNB阳性，而PDM中313例患者中有17例（5.4%）SLNB阳性。
与其他黑色素瘤变体相比，DM中SLNB阳性率降低；然而，淋巴结状态仍可能预测DFS和MSS。与PDM相比，MDM发生区域淋巴结微转移的几率更高，MDM的DFS和MSS可能低于PDM。我们建议考虑对MDM进行SLNB。然而，由于PDM中SLNB阳性率如此之低，且缺乏对患者进行分层的高危特征，我们不建议对PDM进行SLNB。
