Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Norwich Medical School, University of East Anglia Norwich Research Park, Norwich, UK.
Br J Surg. 2020 May;107(6):669-676. doi: 10.1002/bjs.11460. Epub 2020 Feb 19.
Sentinel lymph node biopsy (SLNB) is an important staging tool for the management of melanoma. A multicentre study was done to validate previous findings that the timing of lymphoscintigraphy influences the accuracy of SLNB and patient outcomes, particularly survival.
Data were reviewed on patients undergoing SLNB for melanoma at three centres in the UK and Sweden, examining the effect of timing of SLNB after nuclear medicine scanning. Kaplan-Meier survival analysis was used to assess overall (OS), disease-specific (DSS) and progression-free (PFS) survival, stratified by timing of lymphoscintigraphy. Independent risk factors for survival were identified by Cox multivariable regression analysis.
A total of 2270 patients were identified. Median follow-up was 56 months. Univariable analysis showed a 4·2 per cent absolute and 35·5 per cent relative benefit in DSS (hazard ratio 1·36, 95 per cent c.i. 1·05 to 1·74; P = 0·018) for 863 patients whose SLNB was performed up to 12 h after lymphoscintigraphy compared with 1407 patients who had surgery after more than 12 h. There were similar OS and PFS benefits (P = 0·036 and P = 0·022 respectively). Multivariable analysis identified timing of lymphoscintigraphy as an independent predictor of OS (P = 0·017) and DSS (P = 0·030). There was an excess of nodal recurrences as first site of recurrence in the group with delayed surgery (4·5 versus 2·5 per cent; P = 0·008).
Delaying SLNB beyond 12 h after lymphoscintigraphy with Tc-labelled nanocolloid has a significant negative survival impact in patients with melanoma.
前哨淋巴结活检（SLNB）是黑色素瘤治疗中一种重要的分期工具。我们进行了一项多中心研究，旨在验证先前的发现，即淋巴闪烁显像的时间会影响 SLNB 的准确性和患者结局，尤其是生存情况。
我们对英国和瑞典 3 个中心的黑色素瘤患者进行 SLNB 的数据进行了回顾，研究了 SLNB 进行时间对核医学扫描后淋巴结闪烁显像的影响。采用 Kaplan-Meier 生存分析法评估整体生存（OS）、疾病特异性生存（DSS）和无进展生存（PFS），并按淋巴闪烁显像时间进行分层。采用 Cox 多变量回归分析确定生存的独立危险因素。
共纳入 2270 例患者，中位随访时间为 56 个月。单变量分析显示，与 1407 例在淋巴闪烁显像后 12 h 以上进行手术的患者相比，2270 例在淋巴闪烁显像后 12 h 内进行 SLNB 的患者，DSS 有 4.2%的绝对获益和 35.5%的相对获益（危险比 1.36，95%CI 1.05 至 1.74；P=0.018）。OS 和 PFS 也有类似的获益（P=0.036 和 P=0.022）。多变量分析显示，淋巴闪烁显像时间是 OS（P=0.017）和 DSS（P=0.030）的独立预测因素。延迟手术组的淋巴结复发作为首发部位的比例更高（4.5%比 2.5%；P=0.008）。
Tc 标记胶体后延迟 12 h 以上进行 SLNB 会显著降低黑色素瘤患者的生存。
