Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK.
Faculty of Medicine and Health, University of Leeds, Leeds, UK.
Ann Surg Oncol. 2021 Mar;28(3):1642-1653. doi: 10.1245/s10434-020-09099-w. Epub 2020 Sep 17.
Extracapsular spread (ECS) is recognized to be a high-risk factor in melanoma patients with macrometastatic (N+) nodal disease; however, ECS risk in sentinel lymph node (SLN) biopsy, micrometastatic stage III disease is ambiguous.
The aim of this study was to examine ECS incidence and its prognostic significance.
A two-center, retrospective analysis of all patients with micro/macrometastatic lymphadenopathy undergoing nodal surgery from 2008 to 2014 was performed. Patient demographics, tumor characteristics, nodal ECS status, and patient outcomes were collected.
Overall, 515 patients with nodal disease were identified (males/females = 277/238); median age was 63 years (range 17-94). There was an increased frequency of ECS disease in N+ disease compared with SLN+ disease (52.4% vs. 16.2%; p < 0.0001). The absolute disease-specific survival (DSS) difference for SLN+ patients was approximately 30% at 10 years (66.2% vs. 37.2%; p < 0.0001), and the prognosis of SLN+/ECS+ patients was identical to N+/ECS- patients. Multivariate analysis demonstrated that ECS status was an independent prognostic indicator for DSS (hazard ratio 2.47, 95% confidence interval 1.87-3.26; p < 0.0001) in patients with SLN+ disease. There were significant differences in nodal burden according to ECS status between the SLN+ and N+ subgroups suggestive of differing biology in ECS+ tumors.
We found that ECS is a significant DSS, progression-free survival, and overall survival indicator in SLN+ and N+ disease. We demonstrated that ECS upstages stage III disease, similar to ulceration in primary melanoma (stage I/II disease). A simplified staging system substituting ECS for N stage accurately stages patients according to prognosis.
在患有巨转移（N+）淋巴结疾病的黑色素瘤患者中，囊外扩散（ECS）被认为是一个高风险因素；然而，在 SLN 活检、微转移 III 期疾病中，ECS 风险并不明确。
本研究旨在探讨 ECS 发生率及其预后意义。
对 2008 年至 2014 年间所有接受淋巴结手术的微/巨转移淋巴结病患者进行了两个中心的回顾性分析。收集患者的人口统计学特征、肿瘤特征、淋巴结 ECS 状态和患者结局。
总体而言，共确定了 515 例淋巴结疾病患者（男性/女性=277/238）；中位年龄为 63 岁（范围 17-94 岁）。与 SLN+疾病相比，N+疾病中 ECS 疾病的频率更高（52.4% vs. 16.2%；p<0.0001）。SLN+患者的绝对疾病特异性生存率（DSS）差异约为 10 年时的 30%（66.2% vs. 37.2%；p<0.0001），并且 SLN+/ECS+患者的预后与 N+/ECS-患者相同。多变量分析表明，ECS 状态是 SLN+疾病患者 DSS 的独立预后指标（危险比 2.47，95%置信区间 1.87-3.26；p<0.0001）。在 SLN+和 N+亚组中，根据 ECS 状态，淋巴结负荷有显著差异，提示 ECS+肿瘤的生物学行为不同。
我们发现 ECS 是 SLN+和 N+疾病中 DSS、无进展生存率和总生存率的重要指标。我们证明 ECS 可使 III 期疾病升级，类似于原发性黑色素瘤的溃疡（I/II 期疾病）。一种替代 N 期的简化分期系统可以根据预后准确地对患者进行分期。
