Liu W F, Yang F J, Niu X H, Sun Y, Huang Z, Jin T, Li Y, Ding Y, Yang F, Chen T
Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing 100035, China.
Department of Pathology, Beijing Jishuitan Hospital, Peking University, Beijing 100035, China.
Zhonghua Zhong Liu Za Zhi. 2021 Jan 23;43(1):147-154. doi: 10.3760/cma.j.cn112152-20200702-00620.
To explore the application of sentinel lymph node biopsy (SLNB) and its prognostic value in the treatment of acral melanoma. We retrospective analyzed 118 patients who underwent sentinel lymph node biopsy from Mar 2012 to Jun 2019 with effective follow-up data available in our institute. We ruled out palpable regional lymph node metastasis with preoperative imaging of MRI and ultrasonography, used the (99)Tc(m)-Dextran (Dx) as a tracer, with intraoperative γ-ray probe positioning for SLN capture. Wide resection and reconstruction in primary lesion followed by complete lymph node dissection were underwent SLN positive patients. Cox regression model were used to analyze the prognostic factors. The patients had an average disease history of 53.6 months (2-360 months), the primary lesion located at hands and feet in 84 cases, while 27 cases were subungual and 7 cases were cutaneous. The mean Breslow depth was 3.6 mm, and 72 cases (61.0%) combined with ulceration. The average number of SLN was 2.8, the SLN positive rate was 24.6% (29/118), and the false-negative rate was 2.5% (3/118). There were 24 cases (20.3%) developed clinically positive metastasis, including 7 cases displayed distant metastasis combined with lymph node metastasis (5.9%), 8 cases with clinically positive lymph node metastasis alone (6.8%), and 9 cases with distant metastasis (7.6%). There were 33 patients in stage Ⅰ, 56 patients in stage Ⅱ and 29 patients in stage Ⅲ, with a 5-years overall survival rate of 69.5%. The Breslow depth is an independent risk factor of SLN positive. While Breslow depth, SLN status, SLN positive number and clinically detectable metastasis are independent prognostic factors of the overall survival (<0.05). Patients without clinically positive regional lymph node metastasis under imaging and physical examinations, SLNB can provide accurate pathologic staging and play an accurate prediction role in the prognostic evaluation. SLNB should be carried out routinely in clinical practice.
探讨前哨淋巴结活检（SLNB）在肢端黑色素瘤治疗中的应用及其预后价值。我们回顾性分析了2012年3月至2019年6月在我院接受前哨淋巴结活检且有有效随访数据的118例患者。我们通过术前MRI和超声影像学检查排除了可触及的区域淋巴结转移，使用（99）Tc（m）-右旋糖酐（Dx）作为示踪剂，术中采用γ射线探测器定位捕获前哨淋巴结。前哨淋巴结阳性患者在原发灶广泛切除并重建后行完整淋巴结清扫。采用Cox回归模型分析预后因素。患者平均病程53.6个月（2 - 360个月），原发灶位于手足84例，甲下27例，皮肤7例。平均Breslow深度为3.6 mm，72例（61.0%）合并溃疡。前哨淋巴结平均个数为2.8个，前哨淋巴结阳性率为24.6%（29/118），假阴性率为2.5%（3/118）。有24例（20.3%）发生临床阳性转移，其中7例表现为远处转移合并淋巴结转移（5.9%），8例仅为临床阳性淋巴结转移（6.8%），9例为远处转移（7.6%）。Ⅰ期33例，Ⅱ期56例，Ⅲ期29例，5年总生存率为69.5%。Breslow深度是前哨淋巴结阳性的独立危险因素。而Breslow深度、前哨淋巴结状态、前哨淋巴结阳性个数及临床可检测到的转移是总生存的独立预后因素（<0.05）。对于影像学和体格检查未发现临床阳性区域淋巴结转移的患者，前哨淋巴结活检可提供准确病理分期，并在预后评估中发挥准确预测作用。临床实践中应常规开展前哨淋巴结活检。
