Collarino Angela, Fuoco Valentina, Garganese Giorgia, Pasciuto Tina, de Koster Elizabeth J, Florit Anita, Fragomeni Simona M, Zagaria Luca, Fragano Alberto, Martinelli Fabio, Ditto Antonino, Seregni Ettore, Scambia Giovanni, Raspagliesi Francesco, Rufini Vittoria, Maccauro Marco
Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy.
Gynecol Oncol. 2023 Mar;170:153-159. doi: 10.1016/j.ygyno.2023.01.011. Epub 2023 Jan 23.
OBJECTIVE: This multicenter study aimed to investigate the role of preoperative lymphatic mapping and sentinel node biopsy (SNB) as well as the impact of negative SNB on loco-regional control and survival in vulvar melanoma patients with clinically negative nodes (cN0). METHODS: Patients who had a proven vulvar melanoma with a Breslow thickness of 1-4 mm, cN0 and underwent a preoperative lymphatic mapping followed by SNB between July 2013 and March 2021 were retrospectively included. Groin recurrence and mortality rate were calculated as absolute and relative frequency. Disease-free survival (DFS) and overall survival (OS) were assessed by the Kaplan-Meier method. We provided a systematic review, searching among PubMed/Medline and Embase libraries. A total of 6 studies were identified (48 patients). RESULTS: A total of 18 women were included. Preoperative planar images showed 51 SNs in 28 groins. Additional SPECT/CT images were acquired in 5/18 cases; SNs were identified pre- and intra-operatively in all cases. A total of 65 SNs were excised from 28 groins. A total of 13/18 (72.2%) patients (21/28 groins, 75%) had negative SNs with no groin recurrences and 12/13 (92.3%) were still alive at last follow-up. Five out of the 18 (27.8%) patients (7/28 groins, 25%) had positive SNs, 2/5 (40%) patients died of cancer after 26.2 and 33.8 months, respectively. The median DFS and OS for the entire cohort were 17.9 months (95% CI, 10.3-19.9) and 65.0 months (95% CI, 26.2-infinite), respectively. The probability of DFS and OS at 3 years were 15.5% (95% CI, 2.6-38.7) and 64.3% (95% CI, 15.5-90.2), respectively. CONCLUSIONS: The use of preoperative lymphatic mapping followed by SNB permits a precise and minimally invasive surgical approach in cN0 vulvar melanoma patients. Negative SNB is associated with low risk of groin relapse and good survival.
目的：本多中心研究旨在探讨术前淋巴绘图和前哨淋巴结活检（SNB）的作用，以及阴性前哨淋巴结活检对外阴黑色素瘤临床淋巴结阴性（cN0）患者局部区域控制和生存的影响。 方法：回顾性纳入2013年7月至2021年3月期间确诊为Breslow厚度为1 - 4 mm、cN0且接受了术前淋巴绘图及随后前哨淋巴结活检的外阴黑色素瘤患者。腹股沟复发率和死亡率以绝对频率和相对频率计算。无病生存期（DFS）和总生存期（OS）采用Kaplan-Meier法评估。我们在PubMed/Medline和Embase数据库中进行了系统检索。共识别出6项研究（48例患者）。 结果：共纳入18名女性。术前平面图像显示28个腹股沟中有51个前哨淋巴结。18例中有5例获取了额外的SPECT/CT图像；所有病例均在术前和术中识别出前哨淋巴结。共从28个腹股沟中切除65个前哨淋巴结。18例患者中有13例（72.2%）（28个腹股沟中的21个，75%）前哨淋巴结阴性，无腹股沟复发，13例中的12例（92.3%）在最后一次随访时仍存活。18例患者中有5例（27.8%）（28个腹股沟中的7个，25%）前哨淋巴结阳性，其中2例（40%）患者分别在26.2个月和33.8个月后死于癌症。整个队列的中位DFS和OS分别为17.9个月（95%CI，10.3 - 19.9）和65.0个月（95%CI，26.2 - 无穷大）。3年时DFS和OS的概率分别为15.5%（95%CI，2.6 - 38.7）和64.3%（95%CI，15.5 - 90.2）。 结论：对于cN0外阴黑色素瘤患者，采用术前淋巴绘图及随后的前哨淋巴结活检可实现精确且微创的手术方式。阴性前哨淋巴结活检与腹股沟复发风险低及良好生存相关。
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