Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
Division of General and Minimally Invasive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
J Surg Res. 2019 Sep;241:15-23. doi: 10.1016/j.jss.2019.03.040. Epub 2019 Apr 17.
Sentinel lymph node biopsy (SLNB) has shown promise in identifying subclinical nodal metastasis in patients with high-risk cutaneous squamous cell carcinoma. However, low metastasis rates may indicate that performing such a procedure in all patients may be unnecessary and costly.
A decision model was developed to analyze costs and survival in patients with head and neck cutaneous squamous cell carcinoma based on their tumor and nodal metastasis staging and whether or not they received an SLNB. Incremental cost-effectiveness ratios were calculated based on the change in quality-adjusted life years (QALYs) and costs (US$) between the different options, with a threshold of $100,000 to determine the most cost-effective strategy. One-way, two-way, and probabilistic sensitivity analyses were performed to validate the results.
Not performing an SLNB results in 12.26 QALYs and a cost of $3712.98. Performing an SLNB resulted in a 0.59 decrease in QALYs and an increase in cost of $1379.58 for an incremental cost-effectiveness ratio of -2338.27. This trend remained the same across all tumor stages and remained consistent within most sensitivity analyses.
In patients with head and neck cutaneous squamous cell carcinoma, the most cost-effective strategy is to not perform SLNBs, regardless of the patient's stage. Low rates of nodal metastasis in addition to low disease-specific death rates were the significant factors in this outcome. Increasing the sensitivity of SLNB would not impact this recommendation unless the rate of nodal metastasis was significantly higher.
前哨淋巴结活检 (SLNB) 已显示出在识别高风险皮肤鳞状细胞癌患者的亚临床淋巴结转移方面的潜力。然而，低转移率可能表明对所有患者进行这样的手术可能是不必要和昂贵的。
根据头颈部皮肤鳞状细胞癌患者的肿瘤和淋巴结转移分期以及是否进行 SLNB，开发了一种决策模型来分析成本和生存情况。基于不同方案之间 QALYs 和成本（美元）的变化，计算了增量成本效益比，以 10 万美元为阈值来确定最具成本效益的策略。进行了单向、双向和概率敏感性分析来验证结果。
不进行 SLNB 会导致 12.26 个 QALYs 和 3712.98 美元的成本。进行 SLNB 会导致 QALYs 减少 0.59 个，成本增加 1379.58 美元，增量成本效益比为-2338.27。这一趋势在所有肿瘤阶段都保持不变，并且在大多数敏感性分析中仍然一致。
在头颈部皮肤鳞状细胞癌患者中，最具成本效益的策略是不进行 SLNB，无论患者的分期如何。低淋巴结转移率加上低疾病特异性死亡率是导致这一结果的重要因素。除非淋巴结转移率显著升高，否则增加 SLNB 的敏感性不会影响这一建议。
