Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
J Am Acad Dermatol. 2022 Oct;87(4):754-760. doi: 10.1016/j.jaad.2022.04.025. Epub 2022 Apr 22.
Approval of adjuvant anti-programmed cell death protein 1 therapy for pathologic stage IIB/C cutaneous melanoma has led some to question the role of sentinel lymph node (SLN) biopsy in the clinical stage IIB/C disease.
To determine the prognostic significance of SLN staging on disease-specific survival (DSS) for clinical stage IIB/C primary cutaneous melanoma in the preimmunotherapy era.
A retrospective cohort study was performed evaluating patients who underwent excision of clinical stage IIB/C cutaneous melanoma using the Surveillance, Epidemiology, and End Results database (2004-2011). Patients who did and did not undergo SLN biopsy were compared using propensity matching, and among those who underwent SLN biopsy, matched patients were further stratified by SLN status (SLN positive [SLN+] or SLN negative [SLN-]).
Of the 8562 patients evaluated, 6021 (70.3%) underwent SLN biopsy. SLN positivity was associated with significantly reduced 5-year DSS among matched patients who underwent SLN biopsy (47.1% SLN+ vs 75.5% SLN-; P < .001). Five-year DSS remained significantly different across matched T-stages: T3b (54.2% SLN+ vs 64.8% SLN-; P = .004), T4a (55.5% SLN+ vs 71.6% SLN-; P = .001), and T4b (38.6% SLN+ vs 60.9% SLN-; P < .001).
Retrospective study.
For patients with clinical stage IIB/C cutaneous melanoma, SLN status provides essential prognostic information.
辅助抗程序性细胞死亡蛋白 1 治疗病理性 IIB/C 期皮肤黑色素瘤的批准，使得一些人对 SLN 活检在临床 IIB/C 期疾病中的作用产生了质疑。
在免疫治疗前时代，确定 SLN 分期对临床 IIB/C 期原发性皮肤黑色素瘤疾病特异性生存（DSS）的预后意义。
本回顾性队列研究使用监测、流行病学和最终结果（SEER）数据库（2004-2011 年），对接受 IIB/C 期皮肤黑色素瘤切除术的患者进行了评估。通过倾向匹配比较了行和未行 SLN 活检的患者，在行 SLN 活检的患者中，进一步根据 SLN 状态（SLN 阳性[SLN+]或 SLN 阴性[SLN-]）对匹配患者进行分层。
在评估的 8562 例患者中，有 6021 例（70.3%）行 SLN 活检。在接受 SLN 活检的匹配患者中，SLN 阳性与显著降低的 5 年 DSS 相关（47.1% SLN+vs 75.5% SLN-；P<0.001）。在匹配的 T 分期中，5 年 DSS 仍存在显著差异：T3b（54.2% SLN+vs 64.8% SLN-；P=0.004）、T4a（55.5% SLN+vs 71.6% SLN-；P=0.001）和 T4b（38.6% SLN+vs 60.9% SLN-；P<0.001）。
回顾性研究。
对于临床 IIB/C 期皮肤黑色素瘤患者，SLN 状态提供了重要的预后信息。
