Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA.
Ann Surg Oncol. 2018 Apr;25(4):903-911. doi: 10.1245/s10434-018-6348-2. Epub 2018 Jan 24.
It is unknown how many patients with localized melanoma undergo sentinel lymph node biopsy (SLNB) or if there is a therapeutic effect from performing nodal staging. We evaluated predictors for SLNB use and assessed if there was an association with improved survival in melanoma patients who had SLNB.
The Surveillance, Epidemiology, and End Results database was queried for clinically node-negative melanoma cases ≥ 0.75 mm in thickness treated from 2010 to 2012. Clinicopathologic factors were correlated with SLNB use, overall survival (OS), and melanoma-specific survival (MSS).
Overall, 13,703 cases were included. SLNB was performed in 1479 of 3439 thin cases (43.0%), 5810 of 8522 intermediate-thickness cases (68.2%), and 916 of 1742 thick cases (52.6%). On multivariable analysis, age ≥ 70 years, thickness < 1 or > 4 mm, head/neck or trunk tumor location, being unmarried, African American race, and residing in a county with a lower level of education were significantly associated with a lower likelihood of performing SLNB (p < 0.05). Patients with intermediate-thickness or thick melanoma who had a SLNB had significantly improved OS and MSS compared with patients who did not have a SLNB (p < 0.05). On multivariable analysis, SLNB use significantly predicted for improved OS and MSS (p < 0.01).
Only 68.2% of intermediate-thickness and 52.6% of thick melanomas are treated with SLNB. Age, thickness, tumor location, race, marital status, and socioeconomic factors appear to influence the performance of SLNB. This data becomes more relevant with the finding that SLNB use is potentially associated with improved survival.
目前尚不清楚有多少局限性黑色素瘤患者接受了前哨淋巴结活检（SLNB），或者进行淋巴结分期是否具有治疗效果。我们评估了 SLNB 应用的预测因素，并评估了 SLNB 是否与接受 SLNB 的黑色素瘤患者的生存改善相关。
从 2010 年至 2012 年，对监测、流行病学和最终结果数据库中厚度≥0.75mm 的临床淋巴结阴性黑色素瘤病例进行了查询。对临床病理因素与 SLNB 应用、总生存（OS）和黑色素瘤特异性生存（MSS）进行了相关性分析。
共有 13703 例患者纳入本研究。在 3439 例薄型病例中，有 1479 例（43.0%）进行了 SLNB；在 8522 例中间厚度病例中，有 5810 例（68.2%）进行了 SLNB；在 1742 例厚型病例中，有 916 例（52.6%）进行了 SLNB。多变量分析显示，年龄≥70 岁、厚度<1 或>4mm、头颈部或躯干肿瘤位置、未婚、非裔美国人种族以及居住在教育程度较低的县与进行 SLNB 的可能性降低显著相关（p<0.05）。与未行 SLNB 的患者相比，行 SLNB 的中间厚度或厚型黑色素瘤患者的 OS 和 MSS 显著改善（p<0.05）。多变量分析显示，SLNB 的应用显著预测了 OS 和 MSS 的改善（p<0.01）。
仅有 68.2%的中间厚度和 52.6%的厚型黑色素瘤接受了 SLNB 治疗。年龄、厚度、肿瘤位置、种族、婚姻状况和社会经济因素似乎影响了 SLNB 的实施。随着 SLNB 应用与生存改善相关这一发现，这些数据变得更加重要。
