Oregon Health & Science University, Department of Surgery, Portland, OR, USA.
Oregon Health & Science University, School of Medicine, Portland, OR, USA.
Am J Surg. 2018 May;215(5):868-872. doi: 10.1016/j.amjsurg.2018.01.033. Epub 2018 Feb 15.
Completion lymph node dissection (CLND) for melanoma after positive sentinel lymph node biopsy (SLNB) was recently shown to improve regional but not overall survival, likely due to the majority of patients harboring no further nodal disease. We sought to determine predictors of non-sentinel node (NSN) positivity.
Retrospective review of prospectively collected data on melanoma patients undergoing SLNB.
116 patients underwent 119 CLNDs. The incidence of NSN positivity was 17.6%; the average number of positive NSNs in those cases was 1.5. Cervical and inguinofemoral location were most likely to yield positive NSN(s) (40% each). Conversely, the axilla was least likely at 18% (p < 0.001). The average number of nodes harvested was 13 for NSN negative cases and 20 for NSN positive cases (p = 0.005). Tumor thickness increased the probability of positive NSN(s) (OR 1.2, p = 0.02).
Tumor thickness and nodal basin were predictors of NSN metastasis, factors that could help determine which patients may benefit from CLND. Further, CLNDs with fewer nodes may inadequately clear residual nodal disease.
在阳性前哨淋巴结活检（SLNB）后进行完全淋巴结清扫（CLND）最近被证明可以改善区域但不能改善整体生存，这可能是由于大多数患者没有进一步的淋巴结疾病。我们试图确定非前哨淋巴结（NSN）阳性的预测因素。
对接受 SLNB 的黑色素瘤患者的前瞻性收集数据进行回顾性分析。
116 名患者接受了 119 次 CLND。NSN 阳性的发生率为 17.6%；在这些病例中，平均阳性 NSN 数为 1.5。颈淋巴结和腹股沟淋巴结最有可能出现阳性 NSN（各占 40%）。相反，腋窝的可能性最小，为 18%（p<0.001）。NSN 阴性病例的平均淋巴结采集数为 13 个，NSN 阳性病例为 20 个（p=0.005）。肿瘤厚度增加了 NSN 阳性的概率（OR 1.2，p=0.02）。
肿瘤厚度和淋巴结区是 NSN 转移的预测因素，这些因素可能有助于确定哪些患者可能从 CLND 中受益。此外，淋巴结采集数较少的 CLND 可能无法清除残留的淋巴结疾病。
