Theile Harrison, Moore Julie, Dunn Nathan, Cossio Danica, Forristal Catherine E, Green Adele C, Smithers B Mark
Discipline of Surgery, The University of Queensland, Brisbane, Queensland, Australia.
Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia.
ANZ J Surg. 2020 Apr;90(4):503-507. doi: 10.1111/ans.15804. Epub 2020 Mar 12.
Optimal management of regional lymph nodes for thin cutaneous melanoma is uncertain. We evaluated regional lymph node involvement and 5-year melanoma-specific survival (MSS) in patients with thin (≤1 mm) primary melanoma.
Patients with a melanoma, American Joint Committee on Cancer Staging 8th Edition pT1a (<0.8 mm) or pT1b (ulceration; and/or 0.8-1.0 mm), diagnosed during 2001-2015 were identified from the Queensland Oncology Repository. We extracted demographic, pathology and clinical details, including sentinel lymph node biopsy (SLNB), regional nodal dissection and nodal recurrence. Poisson regression was used to assess recurrence risk in patients who did not undergo SLNB. The 5-year MSS was calculated using the Kaplan-Maier method with Cox regression to compare survival outcomes according to SLNB performance.
Of the 27 824 eligible patients, 240 (0.9%) underwent SLNB. One hundred and seventy-eight patients (0.6%) without SLNB had nodal recurrence. Of the 4848 patients with a pT1b lesion, 166 (3.4%) had SLNB with 12 (7.2%) positive; of the remainder, 99 (2.1%) had clinical recurrence. Risk of recurrence was higher in males, nodular subtype and T1b lesions and lower if patients were aged >60 years. The 5-year MSS was similar for observed and SLNB cohorts (99.66% versus 98.92%) but worse for T1b lesions (98.90%) and clinical nodal recurrence (66.89%).
Overall prognosis for T1 melanoma is excellent with nodal involvement being rare. However, the American Joint Committee on Cancer 8th Edition T1b melanoma correlates with significantly worse 5-year MSS and increased regional nodal recurrence (notably for 0.8-1.0 mm lesions with ulceration). Further characterization of high-risk groups for nodal positivity that impacts patient outcome is needed for the pT1 melanoma cohort.
对于薄型皮肤黑色素瘤，区域淋巴结的最佳管理尚不确定。我们评估了原发性薄型（≤1毫米）黑色素瘤患者的区域淋巴结受累情况及5年黑色素瘤特异性生存率（MSS）。
从昆士兰肿瘤登记库中识别出2001年至2015年期间诊断为黑色素瘤、美国癌症联合委员会第8版分期为pT1a（<0.8毫米）或pT1b（溃疡；和/或0.8 - 1.0毫米）的患者。我们提取了人口统计学、病理学和临床细节，包括前哨淋巴结活检（SLNB）、区域淋巴结清扫和淋巴结复发情况。采用泊松回归评估未接受SLNB患者的复发风险。使用Kaplan - Maier方法计算5年MSS，并采用Cox回归根据SLNB情况比较生存结局。
在27824名符合条件的患者中，240名（0.9%）接受了SLNB。178名（0.6%）未接受SLNB的患者出现淋巴结复发。在4848名pT1b病变患者中，166名（3.4%）接受了SLNB，其中12名（7.2%）为阳性；其余患者中，99名（2.1%）出现临床复发。男性、结节型亚型和T1b病变患者的复发风险较高，而年龄>60岁的患者复发风险较低。观察队列和SLNB队列的5年MSS相似（99.66%对98.92%），但T1b病变患者（98.90%）和临床淋巴结复发患者（66.89%）的5年MSS较差。
T1期黑色素瘤总体预后良好，淋巴结受累罕见。然而，美国癌症联合委员会第8版T1b期黑色素瘤与5年MSS显著较差及区域淋巴结复发增加相关（特别是对于有溃疡的0.8 - 1.0毫米病变）。对于pT1期黑色素瘤队列，需要进一步明确影响患者结局的淋巴结阳性高危组特征。
