Department of Plastic & Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK. Electronic address: fionnuala.o'
Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
Eur J Surg Oncol. 2018 Nov;44(11):1768-1772. doi: 10.1016/j.ejso.2018.06.011. Epub 2018 Jun 23.
Sentinel lymph node biopsy (SLNB) in cutaneous melanoma (CM) is performed to identify patient at risk of regional and distant relapse. We hypothesized that timing of lymphoscintigraphy may influence the accuracy of SLNB and patient outcomes.
We reviewed prospective data on patients undergoing SLNB for CM at a large university cancer-center between 2008 and 2015, examining patient and tumor demographics and time between lymphoscintigraphy (LS) and SLNB. Kaplan-Meier survival analysis assessed disease-specific (DSS) and overall-survival (OS), stratified by timing of LS. Cox multivariate regression analysis assessed independent risk factors for survival.
We identified 1015 patients. Median follow-up was 45 months (IQR 26-68 months). Univariate analysis showed a 6.8% absolute DSS (HR 1.6 [1.03-2.48], p = 0.04) benefit and a 10.7% absolute OS (HR 1.64 [1.13-2.38], p = 0.01) benefit for patients whose SLNB was performed < 12 h of LS (n = 363) compared to those performed >12 h (n = 652). Multivariate analysis identified timing of LS as an independent predictor of OS (p = 0.007) and DSS (p = 0.016) when competing with age, sex, Breslow thickness (BT) and SLN status. No difference in nodal relapse rates (5.2% v 4.6%; p = 0.67) was seen. Both groups were matched for age, sex, BT and SLN status.
These data have significant implications for SLNB services, suggesting delaying SLNB >12 h after LS using a Tc99-labelled nanocolloid has a significant negative survival impact for patients and should be avoided. We hypothesise that temporal tracer migration is the underlying cause and advocate further trials investigating alternative, 'stable' tracer-agents.
前哨淋巴结活检（SLNB）在皮肤黑色素瘤（CM）中进行，以确定有区域和远处复发风险的患者。我们假设淋巴闪烁显像的时间可能会影响 SLNB 的准确性和患者的结局。
我们回顾了 2008 年至 2015 年间在一家大型大学癌症中心接受 CM SLNB 的前瞻性数据，检查了患者和肿瘤的人口统计学数据以及淋巴闪烁显像（LS）和 SLNB 之间的时间。生存分析评估了疾病特异性（DSS）和总生存（OS），按 LS 的时间进行分层。Cox 多变量回归分析评估了生存的独立危险因素。
我们确定了 1015 例患者。中位随访时间为 45 个月（IQR 26-68 个月）。单因素分析显示，SLNB 进行时间<12 小时（n=363）与>12 小时（n=652）相比，DSS 的绝对获益为 6.8%（HR 1.6 [1.03-2.48]，p=0.04），OS 的绝对获益为 10.7%（HR 1.64 [1.13-2.38]，p=0.01）。多因素分析发现，LS 时间是 OS（p=0.007）和 DSS（p=0.016）的独立预测因素，与年龄、性别、Breslow 厚度（BT）和 SLN 状态相比。未观察到淋巴结复发率（5.2%比 4.6%；p=0.67）的差异。两组在年龄、性别、BT 和 SLN 状态方面匹配。
这些数据对 SLNB 服务具有重要意义，表明使用 Tc99 标记的纳米胶体 LS 后>12 小时延迟 SLNB 对患者的生存有显著的负面影响，应避免使用。我们假设，时间追踪剂的迁移是潜在的原因，并提倡进一步研究替代的“稳定”追踪剂。
