Division of Surgical Oncology, Ohio State University Wexner Medical Center, Columbus, OH, USA.
Division of Surgical Oncology, University of Virginia, Charlottesville, VA, USA.
Ann Surg Oncol. 2017 Sep;24(9):2728-2733. doi: 10.1245/s10434-017-5883-6. Epub 2017 May 15.
Sentinel lymph node biopsy (SLNB) is routinely performed for primary cutaneous melanomas; however, limited data exist for SLNB after locally recurrent (LR) or in-transit (IT) melanoma.
Data from three centers performing SLNB for LR/IT melanoma (1997 to the present) were reviewed, with the aim of assessing (1) success rate; (2) SLNB positivity; and (3) prognostic value of SLNB in this population.
The study cohort included 107 patients. Management of the primary melanoma included prior SLNB for 56 patients (52%), of whom 10 (18%) were positive and 12 had complete lymph node dissections (CLNDs). In the present study, SLNB was performed for IT disease (48/107, 45%) or LR melanoma (59/107, 55%). A sentinel lymph node (SLN) was removed in 96% (103/107) of cases. Nodes were not removed for four patients due to lymphoscintigraphy failures (2) or nodes not found during surgery (2). SLNB was positive in 41 patients (40%, 95% confidence interval (CI) 31.5-50.5), of whom 35 (88%) had CLND, with 13 (37%) having positive nonsentinel nodes. Median time to disease progression after LR/IT metastasis was 1.4 years (95% CI 0.75-2.0) for patients with a positive SLNB, and 5.9 years (95% CI 1.7-10.2) in SLNB-negative patients (p = 0.18). There was a trend towards improved overall survival for patients with a negative SLNB (p = 0.06).
SLNB can be successful in patients with LR/IT melanoma, even if prior SLNB was performed. In this population, the rates of SLNB positivity and nonsentinel node metastases were 40% and 37%, respectively. SLNB may guide management and prognosis after LR/IT disease.
前哨淋巴结活检 (SLNB) 已常规用于原发性皮肤黑色素瘤；然而，对于局部复发 (LR) 或远处转移 (IT) 黑色素瘤的 SLNB，数据有限。
回顾了三个中心对 LR/IT 黑色素瘤进行 SLNB 的数据（1997 年至今），旨在评估 (1) 成功率；(2) SLNB 阳性率；(3) 该人群中 SLNB 的预后价值。
研究队列包括 107 例患者。对原发性黑色素瘤的治疗包括 56 例患者 (52%) 的先前 SLNB，其中 10 例 (18%) 阳性，12 例进行了完全淋巴结清扫术 (CLND)。在本研究中，对 IT 疾病 (48/107，45%) 或 LR 黑色素瘤 (59/107，55%) 进行了 SLNB。96% (103/107) 的病例中切除了前哨淋巴结 (SLN)。由于淋巴闪烁显像失败 (2 例) 或术中未找到淋巴结 (2 例)，有 4 例患者未切除淋巴结。41 例患者 (40%，95%置信区间 [CI] 31.5-50.5) 的 SLNB 阳性，其中 35 例 (88%) 进行了 CLND，13 例 (37%) 有非前哨淋巴结转移。LR/IT 转移后疾病进展的中位时间为 SLNB 阳性患者 1.4 年 (95% CI 0.75-2.0)，SLNB 阴性患者为 5.9 年 (95% CI 1.7-10.2) (p = 0.18)。SLNB 阴性患者的总生存率有改善的趋势 (p = 0.06)。
即使先前进行了 SLNB，LR/IT 黑色素瘤患者的 SLNB 也能成功进行。在该人群中，SLNB 阳性率和非前哨淋巴结转移率分别为 40%和 37%。SLNB 可能指导 LR/IT 疾病后的管理和预后。
