Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan.
Clin Cancer Res. 2019 Dec 15;25(24):7585-7593. doi: 10.1158/1078-0432.CCR-19-1194. Epub 2019 Sep 30.
In patients with cutaneous melanoma, metastasis in a nonsentinel lymph node (non-SLN) is a strong independent adverse prognostic factor. However, patients with a tumor-involved SLN no longer routinely undergo completion lymph node dissection (CLND). We hypothesized that SLN tumor burden may predict non-SLN tumor burden.
We compared tumor burden parameters between SLN and non-SLN in patients with cutaneous melanoma who underwent SLN biopsy with a positive SLN during 2003 to 2008 at The University of Texas MD Anderson Cancer Center.
We identified 336 eligible patients with a positive SLN. Of these, 308 (92%) underwent CLND, and 35 (10%) had non-SLN metastasis. The median follow-up time was 6.0 years. For patients with maximum diameter of tumor in the SLN ≤2.0 mm, >2.0-5.0 mm, and >5.0 mm, non-SLN metastasis was detected in 5 of 200 patients (3%), 10 of 63 patients (16%), and 20 of 57 patients (35%), and the mean maximum diameters of the non-SLN tumor deposits were 0.09, 1.56, and 2.71 mm, respectively ( < 0.0001). The percentage of patients with both subcapsular and intraparenchymal non-SLN tumor was higher for patients with SLN tumor in both locations than for patients with SLN tumor in only one location ( < 0.0001). Extranodal extension in a non-SLN was more common in patients with extranodal extension in an SLN ( = 0.003).
In patients with cutaneous melanoma who undergo CLND, SLN tumor burden predicts non-SLN tumor burden. SLN tumor burden parameters provide accurate prognostic stratification independent of non-SLN status and should be considered for incorporation into future staging systems and integrated risk models.
在患有皮肤黑色素瘤的患者中，非前哨淋巴结（non-SLN）转移是一个强烈的独立不良预后因素。然而，前哨淋巴结阳性的患者不再常规进行淋巴结清扫术（CLND）。我们假设前哨淋巴结肿瘤负荷可以预测非前哨淋巴结肿瘤负荷。
我们比较了 2003 年至 2008 年间在德克萨斯大学 MD 安德森癌症中心接受前哨淋巴结活检且前哨淋巴结阳性的皮肤黑色素瘤患者的前哨淋巴结和非前哨淋巴结的肿瘤负荷参数。
我们确定了 336 名前哨淋巴结阳性的合格患者。其中，308 名（92%）接受了 CLND，35 名（10%）有非前哨淋巴结转移。中位随访时间为 6.0 年。在前哨淋巴结肿瘤最大直径≤2.0mm、>2.0-5.0mm 和>5.0mm 的患者中，非前哨淋巴结转移分别为 200 名患者中的 5 名（3%）、63 名患者中的 10 名（16%）和 57 名患者中的 20 名（35%），非前哨淋巴结肿瘤沉积的平均最大直径分别为 0.09、1.56 和 2.71mm（<0.0001）。前哨淋巴结肿瘤位于两个部位的患者比前哨淋巴结肿瘤位于一个部位的患者具有更多的非前哨淋巴结包膜下和实质内肿瘤（<0.0001）。非前哨淋巴结内的淋巴结外延伸在 SLN 中有淋巴结外延伸的患者中更为常见（=0.003）。
在接受 CLND 的皮肤黑色素瘤患者中，前哨淋巴结肿瘤负荷预测非前哨淋巴结肿瘤负荷。前哨淋巴结肿瘤负荷参数提供了独立于非前哨淋巴结状态的准确预后分层，应考虑将其纳入未来的分期系统和综合风险模型。
