Department of Plastic Surgery, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Teiskontie 35, 33521, Tampere, Finland.
Department of Dermatology, Skin Cancer Unit, Helsinki University Central Hospital, Helsinki, Finland.
Clin Exp Metastasis. 2020 Apr;37(2):365-376. doi: 10.1007/s10585-020-10028-0. Epub 2020 Feb 19.
Recent data have demonstrated no survival benefit to immediate completion lymph node dissection (CLND) for positive sentinel node (SN) disease in melanoma. It is important to identify parameters in positive SNs, which predict prognosis in melanoma patients. These might provide prognostic value in staging systems and risk models by guiding high-risk patients' adjuvant therapy in clinical practice. In this retrospective study of university hospital melanoma database we analyzed tumor burden and prognosis in patients with positive SNs. Patients were stratified by the diameter of tumor deposit, distribution of metastatic focus in SN, ulceration and number of metastatic SNs. These were incorporated in Cox proportional hazard regression models. Predictive ability was assessed using Akaike information criterion and Harrell's concordance index. A total of 110 patients had positive SN and 104 underwent CLND. Twenty-two (21%) patients had non-SN metastatic disease on CLND. The 5-year melanoma specific survival for CLND-negative patients was 5.00 years (IQR 3.23-5.00, range 0.72-5.00) compared to 3.69 (IQR 2.28-4.72, range 1.01-5.00) years in CLND-positive patients (HR 2.82 (95% CI 1.17-6.76, p = 0.020).The models incorporating distribution of metastatic focus and the largest tumor deposit in SN had highest predictive ability. According to Cox proportional hazard regression models, information criterions and c-index, the diameter of tumor deposit > 4 mm with multifocal location in SN despite of number of metastatic SN were the most important parameters. According to the diameter of tumor deposit and distribution of metastatic focus in SN, adequate stratification of positive SN patients was possible and risk classes for patients were identified.
最近的数据表明，对于黑色素瘤中阳性前哨淋巴结 (SN) 疾病，立即完成淋巴结清扫术 (CLND) 并不能带来生存获益。重要的是要确定阳性 SN 中的参数，这些参数可以预测黑色素瘤患者的预后。这些参数可能通过指导高危患者的辅助治疗，为分期系统和风险模型提供预后价值。在这项对大学医院黑色素瘤数据库的回顾性研究中，我们分析了阳性 SN 患者的肿瘤负担和预后。患者根据肿瘤沉积的直径、SN 中转移性病灶的分布、溃疡和转移性 SN 的数量进行分层。这些参数被纳入 Cox 比例风险回归模型。使用赤池信息量准则和 Harrell 一致性指数评估预测能力。共有 110 例患者 SN 阳性，104 例患者行 CLND。22 (21%)例患者在 CLND 时非 SN 转移性疾病。CLND 阴性患者的 5 年黑色素瘤特异性生存率为 5.00 年 (IQR 3.23-5.00，范围 0.72-5.00)，而 CLND 阳性患者为 3.69 年 (IQR 2.28-4.72，范围 1.01-5.00) (HR 2.82 (95% CI 1.17-6.76，p = 0.020)。纳入转移性病灶分布和 SN 中最大肿瘤沉积的模型具有最高的预测能力。根据 Cox 比例风险回归模型、信息准则和 C 指数，SN 中肿瘤沉积直径 > 4mm 且存在多个病灶，尽管转移性 SN 数量较多，是最重要的参数。根据 SN 中肿瘤沉积的直径和转移性病灶的分布，对阳性 SN 患者进行了适当的分层，并确定了患者的风险类别。
