Borgognoni Lorenzo, Bellucci Francesco, Urso Carmelo, Manneschi Gianfranco, Gerlini Gianni, Brandani Paola, Chiarugi Cristina, Gelli Riccardo, Giannotti Vanni, Sestini Serena
Department of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit.
Department of Anatomic Pathology, Dermatopathology Section, S.M. Annunziata Hospital, AUSL Toscana Centro.
Melanoma Res. 2019 Apr;29(2):163-171. doi: 10.1097/CMR.0000000000000481.
This study aimed to investigate the sentinel lymph node (SLN) tumour burden to predict the non-SLN positivity rate and the survival of melanoma patients to evaluate whether SLN microstaging could predict the prognosis, similar to what is currently performed by examining the lymph nodes excised by complete lymph node dissection. Of 1130 consecutive melanoma patients who underwent SLN biopsy, 226 were tumour-positive and 204 were included in this study. SLN metastases were classified on the basis of dimensional (Rotterdam) and topographic (Dewar) criteria either separately or combined. SLN metastases more than 1 mm in diameter had the highest non-SLN positivity rate (31%) compared with metastases 0.1-1 mm (10%) and less than 0.1 mm (4%). The non-SLN positivity rate was 45% for extensive metastases, 5% for subcapsular metastases and 23-29% for parenchymal, combined and multifocal classes, therefore suggesting a simplification of the parenchymal SLN metastases into only two classes: extensive and 'not extensive'. The dimension of the metastasis was correlated with a different non-SLN positivity rate only when the metastasis was in the parenchyma (20-36%) and not when it was in the subcapsular location (4-7%). Interestingly, the 5-year melanoma-specific survival (MSS) was 89% for patients with subcapsular less than 0.1 mm metastases and 45% for patients with nonsubcapsular more than 1 mm metastases (P=0.017). In the parenchyma, larger metastases (>1 mm) were related to a lower 5-year MSS (46%) than smaller (<1 mm) metastases (MSS 77%). SLN tumour burden characterization can be simplified and it can provide prognostic information on non-SLN positivity and survival, which is especially useful in patients who do not undergo complete lymph node dissection.
本研究旨在调查前哨淋巴结（SLN）的肿瘤负荷，以预测非前哨淋巴结阳性率及黑色素瘤患者的生存率，从而评估SLN微分期能否像目前通过检查完整淋巴结清扫所切除的淋巴结那样预测预后。在1130例连续接受SLN活检的黑色素瘤患者中，226例肿瘤呈阳性，204例纳入本研究。SLN转移灶根据维度（鹿特丹）和拓扑（杜瓦）标准单独或联合进行分类。直径超过1mm的SLN转移灶的非前哨淋巴结阳性率最高（31%），而直径为0.1 - 1mm的转移灶为10%，小于0.1mm的转移灶为4%。广泛转移的非前哨淋巴结阳性率为45%，被膜下转移为5%，实质、联合及多灶性转移为23 - 29%，因此提示可将实质SLN转移灶简化为仅两类：广泛转移和“非广泛转移”。仅当转移灶位于实质内时（20 - 36%），转移灶大小才与不同的非前哨淋巴结阳性率相关，而位于被膜下时（4 - 7%）则不然。有趣的是，被膜下转移灶小于0.1mm的患者5年黑色素瘤特异性生存率（MSS）为89%，非被膜下转移灶大于1mm的患者为45%（P = 0.017）。在实质内，较大转移灶（>1mm）的5年MSS（46%）低于较小转移灶（<1mm）（MSS 77%）。SLN肿瘤负荷特征可简化，且能提供关于非前哨淋巴结阳性及生存的预后信息，这对未进行完整淋巴结清扫的患者尤为有用。
