III期黑色素瘤无即刻完成淋巴结清扫的辅助治疗。

Adjuvant Therapy for Stage III Melanoma Without Immediate Completion Lymph Node Dissection.

作者信息

Torphy Robert J, Friedman Chloe, Ho Felix, Leonard Laura D, Thieu Daniel, Lewis Karl D, Medina Theresa M, Robinson William A, Gonzalez Rene C, Stewart Camille L, Kounalakis Nicole, McCarter Martin D, Gleisner Ana

机构信息

Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

出版信息

Ann Surg Oncol. 2022 Feb;29(2):806-815. doi: 10.1245/s10434-021-10775-8. Epub 2021 Sep 19.

DOI:10.1245/s10434-021-10775-8

PMID:34537899

Abstract

INTRODUCTION

For patients with stage III melanoma with occult lymph node metastasis, the use of adjuvant therapy is increasing, and completion lymph node dissection (CLND) is decreasing. We sought to evaluate the use of modern adjuvant therapy and outcomes for patients with stage III melanoma who did not undergo CLND.

METHODS

Patients with a positive SLNB from 2015 to 2020 who did not undergo CLND were evaluated retrospectively. Nodal recurrence, recurrence-free survival (RFS), distant metastasis-free survival (DMFS), and melanoma-specific survival were evaluated.

RESULTS

Among 90 patients, 56 (62%) received adjuvant therapy and 34 (38%) underwent observation alone. Patients who received adjuvant therapy were younger (mean age: 53 vs. 65, p < 0.001) and had higher overall stage (Stage IIIb/c 75% vs. 54%, p = 0.041). Disease recurred in 12 of 34 patients (35%) in the observation group and 11 of 56 patients (20%) in the adjuvant therapy group. The most common first site of recurrence was distant recurrence alone (5/34 patients) in the observation group and nodal recurrence alone (8/90 patients) in the adjuvant therapy group. Despite more adverse nodal features in the adjuvant therapy group, 24-month nodal recurrence rate and RFS were not significantly different between the adjuvant and observation cohorts (nodal recurrence rate: 26% vs. 20%, p = 0.68; RFS: 75% vs. 61%, p = 0.39). Among patients with stage IIIb/c disease, adjuvant therapy was associated with a significantly improved 24-month DMFS (86% vs. 59%, p = 0.04).

CONCLUSIONS

In this early report, modern adjuvant therapy in patients who forego CLND is associated with longer DMFS among patients with stage IIIb/c disease.

摘要

引言

对于伴有隐匿性淋巴结转移的III期黑色素瘤患者，辅助治疗的应用正在增加，而根治性淋巴结清扫术（CLND）的应用正在减少。我们试图评估未接受CLND的III期黑色素瘤患者现代辅助治疗的应用情况及预后。

方法

对2015年至2020年期间前哨淋巴结活检（SLNB）呈阳性但未接受CLND的患者进行回顾性评估。评估淋巴结复发、无复发生存期（RFS）、无远处转移生存期（DMFS）和黑色素瘤特异性生存期。

结果

90例患者中，56例（62%）接受了辅助治疗，34例（38%）仅接受观察。接受辅助治疗的患者更年轻（平均年龄：53岁对65岁，p < 0.001）且总体分期更高（IIIb/c期75%对54%，p = 0.041）。观察组34例患者中有12例（35%）疾病复发，辅助治疗组56例患者中有11例（20%）复发。最常见的首个复发部位在观察组是单纯远处复发（5/34例患者），在辅助治疗组是单纯淋巴结复发（8/90例患者）。尽管辅助治疗组的淋巴结不良特征更多，但辅助治疗组和观察组之间的24个月淋巴结复发率和RFS无显著差异（淋巴结复发率：26%对20%，p = 0.68；RFS：75%对61%，p = 0.39）。在IIIb/c期疾病患者中，辅助治疗与显著改善的24个月DMFS相关（86%对59%，p = 0.04）。