Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Ann Surg Oncol. 2019 Sep;26(9):2846-2854. doi: 10.1245/s10434-019-07509-2. Epub 2019 Jun 17.
The Multicenter Selective Lymphadenectomy Trial II results suggest that future radical axillary lymphadenectomy (ALND) will be performed for bulkier metastatic disease. The utility of level III lymph node (LN) dissection in melanoma patients with palpable metastatic axillary disease was assessed.
We performed a retrospective chart review of patients who underwent ALND (levels I-III) for metastatic melanoma from 2005 to 2017. We assessed the frequency of level III positive nodes in patients undergoing radical axillary lymphadenectomy (ALND) for metastatic melanoma as well as the prognostic role and factors predictive of level III LN positivity.
A total of 190 patients underwent ALND during the study period. Of these, 85 patients had palpable axillary disease, of which 71 had separate level III pathologic assessment. Level III LNs were positive in 16.9% of patients with palpable disease versus 0% with positive sentinel LN. The 1-, 3-, and 5-year overall survival (OS) for patients with palpable disease was 82.9%, 58.9%, and 39.0%, respectively. Median disease-free survival was 26.8 months, and the axillary recurrence rate was 8.2%. High level I/II LN ratio, BRAF mutation, and total LN examined were significant predictors of level III positivity (all p ≤ 0.05). Patients with positive level III LN had significantly worse OS (median 18.6 months vs. not reached, p = 0.001). No preoperative factors were predictive of level III LN positivity.
Level III axillary disease is not uncommon in melanoma patients with clinically palpable nodal disease and provides useful prognostic information for OS. We recommend that full level I-III ALND be considered in this patient cohort.
多中心选择性淋巴结清扫试验 II 的结果表明，未来的根治性腋窝淋巴结清扫术 (ALND) 将针对更具侵袭性的转移性疾病进行。评估了在有可触及转移性腋窝疾病的黑色素瘤患者中进行 III 级淋巴结 (LN) 解剖的效用。
我们对 2005 年至 2017 年间因转移性黑色素瘤而行 ALND（I-III 级）的患者进行了回顾性图表审查。我们评估了在接受根治性腋窝淋巴结清扫术 (ALND) 治疗转移性黑色素瘤的患者中 III 级阳性淋巴结的频率，以及 III 级 LN 阳性的预后作用和预测因素。
在研究期间，共有 190 名患者接受了 ALND。其中，85 名患者有可触及的腋窝疾病，其中 71 名患者有单独的 III 级病理评估。有可触及疾病的患者中，III 级 LN 阳性的比例为 16.9%，而前哨淋巴结阳性的患者中为 0%。有可触及疾病的患者的 1 年、3 年和 5 年总生存率 (OS) 分别为 82.9%、58.9%和 39.0%。中位无病生存时间为 26.8 个月，腋窝复发率为 8.2%。高 I/II 级 LN 比、BRAF 突变和检查的总 LN 是 III 级阳性的显著预测因素（均 p≤0.05）。III 级 LN 阳性的患者 OS 明显更差（中位 18.6 个月 vs. 未达到，p=0.001）。术前无任何因素可预测 III 级 LN 阳性。
在有临床可触及淋巴结疾病的黑色素瘤患者中，III 级腋窝疾病并不少见，可为 OS 提供有用的预后信息。我们建议在这部分患者中考虑进行完整的 I-III 级 ALND。
