头颈部黑色素瘤前哨淋巴结活检：长期结果、预后价值、准确性和安全性。
Sentinel Lymph Node Biopsy in Head and Neck Melanoma: Long-term Outcomes, Prognostic Value, Accuracy, and Safety.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA.
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA.
出版信息
Otolaryngol Head Neck Surg. 2020 Apr;162(4):520-529. doi: 10.1177/0194599819899934. Epub 2020 Feb 11.
OBJECTIVE
To evaluate the long-term outcomes of sentinel lymph node biopsy (SLNB) for head and neck cutaneous melanoma (HNCM).
STUDY DESIGN
Retrospective cohort study.
SETTING
Tertiary academic medical center.
SUBJECTS AND METHODS
Longitudinal review of a 356-patient cohort with HNCM undergoing SLNB from 1997 to 2007.
RESULTS
Descriptive characteristics included the following: age, 53.5 ± 19 years (mean ± SD); sex, 26.8% female; median follow-up, 4.9 years; and Breslow depth, 2.52 ± 1.87 mm. Overall, 75 (21.1%) patients had a positive SLNB. Among patients undergoing completion lymph node dissection following positive SLNB, 20 (27.4%) had at least 1 additional positive nonsentinel lymph node. Eighteen patients with local control and negative SLNB developed regional disease, indicating a false omission rate of 6.4%, including 10 recurrences in previously unsampled basins. Ten-year overall survival (OS) and melanoma-specific survival (MSS) were significantly greater in the negative sentinel lymph node (SLN) cohort (OS, 61% [95% CI, 0.549-0.677]; MSS, 81.9% [95% CI, 0.769-0.873]) than the positive SLN cohort (OS, 31% [95% CI, 0.162-0.677]; MSS, 60.3% [95% CI, 0.464-0.785]) and positive SLN/positive nonsentinel lymph node cohort (OS, 8.4% [95% CI, 0.015-0.474]; MSS, 9.6% [95% CI, 0.017-0.536]). OS was significantly associated with SLN positivity (hazard ratio [HR], 2.39; < .01), immunosuppression (HR, 2.37; < .01), angiolymphatic invasion (HR, 1.91; < .01), and ulceration (HR, 1.86; < .01). SLN positivity (HR, 3.13; < .01), angiolymphatic invasion (HR, 3.19; < .01), and number of mitoses ( = .0002) were significantly associated with MSS. Immunosuppression (HR, 3.01; < .01) and SLN status (HR, 2.84; < .01) were associated with recurrence-free survival, and immunosuppression was the only factor significantly associated with regional recurrence (HR, 6.59; < .01).
CONCLUSIONS
Long-term follow up indicates that SLNB showcases durable accuracy, safety, and prognostic importance for cutaneous HNCM.
目的
评估前哨淋巴结活检（SLNB）治疗头颈部皮肤黑色素瘤（HNCM）的长期结果。
研究设计
回顾性队列研究。
地点
三级学术医疗中心。
受试者和方法
对 1997 年至 2007 年间接受 SLNB 的 356 例 HNCM 患者进行纵向回顾。
结果
描述性特征包括：年龄 53.5±19 岁（均值±标准差）；性别，26.8%为女性；中位随访时间为 4.9 年；Breslow 深度为 2.52±1.87mm。总体而言，75 例（21.1%）患者的 SLNB 呈阳性。在 SLNB 阳性后行淋巴结清扫术的患者中，有 20 例（27.4%）至少有 1 个额外的非前哨淋巴结阳性。18 例局部控制且 SLNB 阴性的患者发生了区域疾病，表明假遗漏率为 6.4%，包括 10 例在先前未取样的区域复发。阴性前哨淋巴结（SLN）队列的 10 年总生存率（OS）和黑色素瘤特异性生存率（MSS）明显高于阳性 SLN 队列（OS：61%[95%CI，0.549-0.677]；MSS：81.9%[95%CI，0.769-0.873]）和阳性 SLN/阳性非前哨淋巴结队列（OS：8.4%[95%CI，0.015-0.474]；MSS：9.6%[95%CI，0.017-0.536]）。OS 与 SLN 阳性显著相关（风险比 [HR]，2.39；<0.01）、免疫抑制（HR，2.37；<0.01）、血管淋巴管侵犯（HR，1.91；<0.01）和溃疡（HR，1.86；<0.01）。SLN 阳性（HR，3.13；<0.01）、血管淋巴管侵犯（HR，3.19；<0.01）和有丝分裂数（=0.0002）与 MSS 显著相关。免疫抑制（HR，3.01；<0.01）和 SLN 状态（HR，2.84；<0.01）与无复发生存率相关，免疫抑制是唯一与区域复发显著相关的因素（HR，6.59；<0.01）。
结论
长期随访表明，SLNB 对头颈部皮肤 HNCM 具有持久的准确性、安全性和预后重要性。
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