Department of Medical Oncology, Institute of Oncology, University of Istanbul, 34390, Istanbul, Capa, Turkey.
Int J Clin Oncol. 2019 Jun;24(6):721-726. doi: 10.1007/s10147-019-01410-4. Epub 2019 Feb 20.
Even though both the involvement of regional lymph nodes and the number of metastatic lymph nodes are regarded as major determinants of survival in cutaneous melanoma, the extent of node dissection has been analyzed as an independent prognostic indicator in only a few studies. This study aims to determine how the lymph node ratio (NR) (ratio of positive nodes to total nodes removed) might predict the disease relapse and survival in node-positive melanoma.
A total of 317 patients with stage III primary melanoma were included in the study and reviewed retrospectively. All patients had nodal staging (N) by radical lymph node dissection. Patients were divided into three groups based on NR1 ≤ 10%, NR2 10-25%, and NR3 > 25%.
The median age was 50 years (range 16-86) and men were predominant (59.3%). The majority of the patients had thicker Breslow depth (> 2 mm) (83.3%), higher mitotic rate (> 2/mm) (64.1%) and ulcerated lesions (69.4%). The median number of positive nodes was 1 (range 1-32). The largest group was N1 (52.4%), which was followed by N2 (29.6%) and N3 (18%). The ratios of patients were 37.5%, 35.3%, and 27.1% in NR1, NR2, and NR3, respectively. The median number of excised lymph nodes was 13 (range 1-73). For all patients the estimated 5-and 10-year relapse-free survival (RFS) rates were 41% and 39%, respectively; and the estimated 5-and 10-year overall survival (OS) rates were 51% and 42%, respectively. Nodular histopathology, ulcerated lesions, higher mitotic rates, and higher node substages were the independent variables that were inversely correlated with survival for all patients; and NR was one of the significant prognostic factors and strongest predictors of relapse and survival (p = 0.03 and p = 0.01, respectively).
Our results suggest that, apart from the conventional nodal status, NR is an independent prognostic factor-regarding both RFS and OS in stage III cutaneous melanoma.
尽管区域淋巴结的受累情况和转移淋巴结的数量被认为是皮肤黑色素瘤生存的主要决定因素，但淋巴结清扫的范围仅在少数研究中被分析为独立的预后指标。本研究旨在确定淋巴结比率（NR）（阳性淋巴结与切除的总淋巴结之比）如何预测阳性淋巴结黑色素瘤的疾病复发和生存。
共纳入 317 例 III 期原发性黑色素瘤患者，进行回顾性研究。所有患者均行根治性淋巴结清扫术进行淋巴结分期（N）。根据 NR1≤10%、NR2 10-25%和 NR3＞25%，将患者分为三组。
中位年龄为 50 岁（范围 16-86 岁），男性为主（59.3%）。大多数患者有较厚的 Breslow 深度（＞2mm）（83.3%）、较高的有丝分裂率（＞2/mm）（64.1%）和溃疡病变（69.4%）。阳性淋巴结的中位数为 1 个（范围 1-32 个）。最大的组是 N1（52.4%），其次是 N2（29.6%）和 N3（18%）。NR1、NR2 和 NR3 组的患者比例分别为 37.5%、35.3%和 27.1%。所有患者的中位淋巴结切除数为 13 个（范围 1-73 个）。所有患者的 5 年和 10 年无复发生存率（RFS）分别估计为 41%和 39%；5 年和 10 年总生存率（OS）分别估计为 51%和 42%。结节性组织病理学、溃疡病变、较高的有丝分裂率和较高的淋巴结亚分期是所有患者生存的独立负相关变量；NR 是复发和生存的重要预后因素和最强预测因素之一（p=0.03 和 p=0.01）。
我们的研究结果表明，除了传统的淋巴结状态外，NR 是 III 期皮肤黑色素瘤 RFS 和 OS 的独立预后因素。
