Nelson Daniel W, Stern Stacey, Elashoff David E, Elashoff Robert, Thompson John F, Mozzillo Nicola, Nieweg Omgo E, Hoekstra Harald J, Cochran Alistair J, Faries Mark B
Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA.
Department of Biostatistics, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA.
J Am Coll Surg. 2017 Aug;225(2):302-311. doi: 10.1016/j.jamcollsurg.2017.05.013. Epub 2017 Jun 28.
Hypothetically, delay between melanoma diagnosis and SLNB could affect outcomes, either adversely by allowing growth and dissemination of metastases, or beneficially by allowing development of an anti-melanoma immune response. Available data are conflicting about the effect of SLNB delay on patient survival. Our objective was to determine whether delay between initial diagnosis and SLNB affects outcomes in patients with cutaneous melanoma.
We performed query and analysis of a large prospectively maintained database of patients with primary cutaneous melanomas undergoing SLNB. An independent dataset from MSLT-1 (Multicenter Selective Lymphadenectomy Trial-1) was used for validation. Primary outcomes included disease-free survival and melanoma-specific survival.
Early and delayed SLNB were defined as less than 30 and 30 or more days from initial diagnosis, respectively. There were 2,483 patients that met inclusion criteria. Positive sentinel lymph nodes were identified in 17.4% (n = 432). Among all patients, 42% had SLNB 30 or more days after diagnosis and 37% of positive sentinel lymph nodes were at 30 or more days. No differences in sex, anatomic site, or histopathologic features were identified between the 2 groups. There was no difference in melanoma-specific survival or disease-free survival between those undergoing early or delayed SLNB. Examination of MSLT-1 trial data similarly demonstrated no difference in survival outcomes.
This, the largest study on this subject to date, found no adverse impact on long-term clinical outcomes of patients due to delay of SLNB beyond 30 days. The MSLT-1 data confirm this result. Patients can be reassured that if the operation is performed 30 or more days after diagnosis, it will not cause harm.
理论上，黑色素瘤诊断与前哨淋巴结活检（SLNB）之间的延迟可能会影响预后，要么因转移灶的生长和扩散而产生不利影响，要么因抗黑色素瘤免疫反应的发展而产生有益影响。关于SLNB延迟对患者生存的影响，现有数据相互矛盾。我们的目的是确定初次诊断与SLNB之间的延迟是否会影响皮肤黑色素瘤患者的预后。
我们对一个前瞻性维护的大型原发性皮肤黑色素瘤患者接受SLNB的数据库进行了查询和分析。来自MSLT-1（多中心选择性淋巴结清扫试验-1）的独立数据集用于验证。主要结局包括无病生存期和黑色素瘤特异性生存期。
早期和延迟SLNB分别定义为自初次诊断起少于30天和30天或更长时间。有2483名患者符合纳入标准。前哨淋巴结阳性率为17.4%（n = 432）。在所有患者中，42%在诊断后30天或更长时间接受了SLNB，37%的前哨淋巴结阳性发生在30天或更长时间。两组在性别、解剖部位或组织病理学特征方面未发现差异。早期或延迟SLNB患者的黑色素瘤特异性生存期或无病生存期无差异。对MSLT-1试验数据的检查同样显示生存结局无差异。
这是迄今为止关于该主题的最大规模研究，发现SLNB延迟超过30天对患者的长期临床结局没有不利影响。MSLT-1数据证实了这一结果。患者可以放心，如果在诊断后30天或更长时间进行手术，不会造成伤害。
