Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
J Am Acad Dermatol. 2019 Feb;80(2):433-440. doi: 10.1016/j.jaad.2018.08.022. Epub 2018 Aug 27.
There is large variability in the risk of sentinel lymph node (SLN) positivity among patients with intermediate thickness melanoma (ITM), with a subgroup of patients exhibiting a low risk of nodal disease.
To identify a group of patients with ITM for whom the risk of nodal disease is low.
A retrospective cohort of patients with ITM who underwent wide excision and nodal evaluation from 2010 to 2013 was identified by using the National Cancer Database and analyzed for the presence of nodal disease. Classification and regression tree analysis identified the most important factors used in a model to identify groups at low risk of SLN positivity.
Of 23,440 patients, 14.7% were found to have nodal metastasis. On classification and regression tree analysis, patients older than 55 years without lymphovascular invasion and with a lesion thickness less than 1.7 mm had an SLN positivity rate of 4.9%. A model using age and thickness in nonulcerated patients identified a low-risk subgroup with a corresponding SLN positivity rate of 4.7%.
This was a retrospective study, and the model developed requires prospective validation.
Patient age is an important factor in estimating risk of SLN in patients with ITM and may help identify patients without ulceration who may be safely spared an SLN biopsy.
在患有中度厚度黑色素瘤（ITM）的患者中，前哨淋巴结（SLN）阳性的风险存在很大差异，其中一部分患者的淋巴结疾病风险较低。
确定一组 ITM 患者的淋巴结疾病风险较低。
通过使用国家癌症数据库，回顾性分析了 2010 年至 2013 年间接受广泛切除和淋巴结评估的 ITM 患者队列，并分析了淋巴结疾病的存在情况。分类和回归树分析确定了用于识别低 SLN 阳性风险组的最重要因素。
在 23440 名患者中，有 14.7%发现有淋巴结转移。在分类和回归树分析中，年龄大于 55 岁、无淋巴血管侵犯且病变厚度小于 1.7mm 的患者 SLN 阳性率为 4.9%。在非溃疡性患者中使用年龄和厚度的模型确定了一个低风险亚组，相应的 SLN 阳性率为 4.7%。
这是一项回顾性研究，所开发的模型需要前瞻性验证。
患者年龄是估计 ITM 患者 SLN 风险的重要因素，可能有助于识别无溃疡的患者，这些患者可以安全地避免 SLN 活检。
