美国国立综合癌症网络指南对薄型黑色素瘤前哨淋巴结活检病例选择及结果的影响

Impact of National Comprehensive Cancer Network Guidelines on Case Selection and Outcomes for Sentinel Lymph Node Biopsy in Thin Melanoma.

作者信息

Nguyen Bichchau, Karia Pritesh S, Hills Victoria M, Besaw Robert J, Schmults Chrysalyne D

机构信息

Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.

Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

出版信息

Dermatol Surg. 2018 Apr;44(4):493-501. doi: 10.1097/DSS.0000000000001369.

DOI:10.1097/DSS.0000000000001369

PMID:29059142

Abstract

BACKGROUND

In 2010, the National Comprehensive Cancer Network (NCCN) recommended sentinel lymph node biopsy (SLNB) for thin melanomas ≤1 mm with mitotic rate (MR) ≥1. In 2016, the criteria were changed to Breslow depth >0.75 mm and MR ≥1.

OBJECTIVE

To compare the impact of 2010 and 2016 NCCN guidelines on SLNB case selection and thin melanoma outcomes.

MATERIALS AND METHODS

Ten-year retrospective cohort of primary thin melanomas at an academic hospital was retroactively stratified for SLNB eligibility using the 2010 and 2016 NCCN guidelines. Nodal recurrence-free survival (NRFS) and disease-free survival (DFS) were compared.

RESULTS

Eight hundred two patients with 859 tumors and median follow-up of 79 months were included. Eleven percent fewer tumors qualified for SLNB under 2016 versus 2010 NCCN guidelines (19% vs 8%, p < .001). The 2016-qualifying cases also had lower 10-year NRFS (70.7% vs 95.2%, p < .001) and DFS (64.7% vs 91.4%, p < .001). Among 2016-qualifying cases, those that received SLNB had improved NRFS (85.6% vs 35.3%, p = .001) and DFS (80.2% vs 30.5%, p < .001) as compared to those that did not receive SLNB.

CONCLUSION

The 2016 NCCN guidelines reduced the number of thin melanomas qualifying for SLNB and more accurately selected cases with higher risks of nodal recurrence and death.

摘要

背景

2010年，美国国立综合癌症网络（NCCN）建议对厚度≤1 mm且有丝分裂率（MR）≥1的薄型黑色素瘤进行前哨淋巴结活检（SLNB）。2016年，标准改为Breslow厚度>0.75 mm且MR≥1。

目的

比较2010年和2016年NCCN指南对SLNB病例选择和薄型黑色素瘤预后的影响。

材料与方法

对一家学术医院原发性薄型黑色素瘤的十年回顾性队列，采用2010年和2016年NCCN指南对SLNB资格进行追溯分层。比较淋巴结无复发生存率（NRFS）和无病生存率（DFS）。

结果

纳入802例患者的859个肿瘤，中位随访时间为79个月。与2010年NCCN指南相比，2016年符合SLNB条件的肿瘤减少了11%（19%对8%，p<.001）。符合2016年标准的病例10年NRFS（70.7%对95.2%，p<.001）和DFS（64.7%对91.4%，p<.001）也较低。在符合2016年标准的病例中，接受SLNB的患者与未接受SLNB的患者相比，NRFS（85.6%对35.3%，p=.001）和DFS（80.2%对30.5%）有所改善。