基因表达谱分析对临床分期为淋巴结阴性的黑色素瘤患者手术分期后决策制定的影响

Impact of Gene Expression Profiling on Decision-Making in Clinically Node Negative Melanoma Patients after Surgical Staging.

作者信息

Schuitevoerder Darryl, Heath Michael, Cook Robert W, Covington Kyle R, Fortino Jeanine, Leachman Sancy, Vetto John T

出版信息

J Drugs Dermatol. 2018 Feb 1;17(2):196-199.

Abstract

INTRODUCTION

The surgeon's role in the follow-up of pathologic stage I and II melanoma patients has traditionally been minimal. Melanoma genetic expression profile (GEP) testing provides binary risk assessment (Class 1-low risk, Class 2-high risk), which can assist in predicting metastasis and formulating appropriate follow up. We sought to determine the impact of GEP results on the management of clinically node negative cutaneous melanoma patients staged with sentinel lymph node biopsy (SLNB).

METHODS

A retrospective review of prospectively gathered data consisting of patients seen from September 2015 - August 2016 was performed to determine whether GEP class influenced follow-up recommendations. Patients were stratified into four groups based on recommended follow-up plan: Dermatology alone, Surgical Oncology, Surgical Oncology with recommendation for adjuvant clinical trial, or Medical and Surgical Oncology.

RESULTS

Of ninety-one patients, 38 were pathologically stage I, 42 stage II, 10 stage III, and 1 stage IV. Combining all stages, GEP Class 1 patients were more likely to be followed by Dermatology alone and less like to be followed by Surgical Oncology with recommendation for adjuvant trial compared to Class 2 patients (P less than 0.001). Among stage 1 patients, Class 1 were more likely to follow up with Dermatology alone compared to Class 2 patients (82 vs. 0%; P less than 0.001). Among stage II patients, GEP Class 1 were more likely to follow up with Dermatology alone (21 vs 0%) and more Class 2 patients followed up with surgery and recommendations for adjuvant trial (36 vs 64%; P less than 0.05). There was no difference in follow up for stage III patients based on the GEP results (P=0.76).

CONCLUSION

GEP results were significantly associated with the management of stage I-II melanoma patients after staging with SLNB. For node negative patients, Class 2 results led to more aggressive follow up and management. J Drugs Dermatol. 2018;17(2):196-199.

摘要

引言

传统上，外科医生在I期和II期黑色素瘤患者随访中的作用微乎其微。黑色素瘤基因表达谱（GEP）检测提供二元风险评估（1类-低风险，2类-高风险），这有助于预测转移并制定适当的随访计划。我们试图确定GEP结果对经前哨淋巴结活检（SLNB）分期的临床淋巴结阴性皮肤黑色素瘤患者管理的影响。

方法

对2015年9月至2016年8月期间前瞻性收集的数据进行回顾性分析，以确定GEP分类是否会影响随访建议。根据推荐的随访计划，将患者分为四组：仅皮肤科、外科肿瘤学、推荐辅助临床试验的外科肿瘤学，或内科和外科肿瘤学。

结果

91例患者中，病理分期I期38例，II期42例，III期10例，IV期1例。综合所有分期，与2类患者相比，1类GEP患者更有可能仅接受皮肤科随访，而接受推荐辅助试验的外科肿瘤学随访的可能性更小（P小于0.001）。在I期患者中，与2类患者相比，1类患者更有可能仅接受皮肤科随访（82%对0%；P小于0.001）。在II期患者中，1类GEP患者更有可能仅接受皮肤科随访（21%对0%），更多的2类患者接受手术及辅助试验建议随访（36%对64%；P小于0.05）。根据GEP结果，III期患者的随访无差异（P = 0.76）。