Rios-Cantu Andrei, Lu Ying, Melendez-Elizondo Victor, Chen Michael, Gutierrez-Range Alejandra, Fadaki Niloofar, Thummala Suresh, West-Coffee Carla, Cleaver James, Kashani-Sabet Mohammed, Leong Stanley P L
Center for Melanoma Research & Treatment, California Pacific Medical Center, 2340 Clay Street, 2nd Floor, San Francisco, CA, 94115, USA.
Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.
Clin Exp Metastasis. 2017 Jun;34(5):345-350. doi: 10.1007/s10585-017-9854-x. Epub 2017 Jul 11.
Melanoma patients with additional positive lymph nodes in the completion lymph node dissection (CLND) following a positive sentinel lymph node (SLN) biopsy would have a poorer prognosis than patients with no additional positive lymph nodes. We hypothesize that the progression of disease from the SLN to the non-SLN compartment is orderly and is associated with the worsening of the disease status. Thus, the SLN and non-SLN compartments are biologically different in that cancer cells, in general, arrive in the SLN compartment before spreading to the non-SLN compartment. To validate this concept, we used a large cohort of melanoma patients from our prospective SLN database in an academic tertiary medical center. Adult cutaneous melanoma patients (n = 291) undergoing CLND after a positive SLN biopsy from 1994 to 2009 were analyzed. Comparison of 5-year disease-free survival and 5-year overall survival between positive (n = 66) and negative (n = 225) CLND groups was made. The 5-year disease-free survival rates were 55% (95% CI 49-62%) for patients with no additional LN on CLND versus 14% (95% CI 8-26%) in patients with positive LN on CLND (p < 0.0001, log-rank test). The median disease-free survival time was 7.4 years with negative CLND (95% CI 4.4-15+ years) and 1.2 years with positive CLND (95% CI 1.0-1.8 years). The 5-year overall survival rates were 67% (95% CI 61-74%) for negative CLND versus 38% (95% CI 28-52%) for positive CLND (p < 0.0001, log-rank test). The median overall survival time was 12.1 years for negative CLND (95% CI 9.3-15+ years) and 2.5 years for positive CLND (95% CI 2.2-5.7 years). This study shows that CLND status is a significant prognostic factor for patients with positive SLNs undergoing CLND. Also, it suggests an orderly progression of metastasis from the SLN to the non-SLN compartment. Thus, the SLN in the regional nodal basin draining the primary melanoma may serve as an important gateway for metastasis to the non-SLN compartment and beyond to the systemic sites.
在前哨淋巴结（SLN）活检呈阳性后进行根治性淋巴结清扫（CLND）时伴有额外阳性淋巴结的黑色素瘤患者，其预后比没有额外阳性淋巴结的患者更差。我们假设疾病从前哨淋巴结转移至非前哨淋巴结区域是有序的，且与疾病状态的恶化相关。因此，前哨淋巴结和非前哨淋巴结区域在生物学上是不同的，一般来说，癌细胞在扩散至非前哨淋巴结区域之前先到达前哨淋巴结区域。为验证这一概念，我们使用了来自一所学术性三级医疗中心前瞻性SLN数据库的大量黑色素瘤患者队列。分析了1994年至2009年间前哨淋巴结活检呈阳性后接受CLND的成年皮肤黑色素瘤患者（n = 291）。对CLND阳性组（n = 66）和阴性组（n = 225）的5年无病生存率和5年总生存率进行了比较。CLND时无额外淋巴结的患者5年无病生存率为55%（95%可信区间49 - 62%），而CLND时有阳性淋巴结的患者为14%（95%可信区间8 - 26%）（p < 0.0001，对数秩检验）。CLND阴性患者的无病生存时间中位数为7.4年（95%可信区间4.4 - 15 +年），CLND阳性患者为1.2年（95%可信区间1.0 - 1.8年）。CLND阴性患者的5年总生存率为67%（95%可信区间61 - 74%），CLND阳性患者为38%（95%可信区间28 - 52%）（p < 0.0001，对数秩检验）。CLND阴性患者的总生存时间中位数为12.1年（95%可信区间9.3 - 15 +年），CLND阳性患者为2.5年（95%可信区间2.2 - 5.7年）。本研究表明，CLND状态是接受CLND的前哨淋巴结阳性患者的一个重要预后因素。此外，它提示了从前哨淋巴结到非前哨淋巴结区域转移的有序进展。因此，引流原发性黑色素瘤的区域淋巴结盆地中的前哨淋巴结可能是转移至非前哨淋巴结区域及更远至全身部位的重要通道。
