Senders Zachary J, Bartlett Edmund K, Mouw Tyler J, McMasters Kelly M, Egger Michael E
Division of Surgical Oncology, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY, USA.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2023 Jun;30(6):3648-3654. doi: 10.1245/s10434-023-13342-5. Epub 2023 Mar 19.
Completion lymph node dissection (CLND) is no longer recommended routinely in the treatment of melanoma. CLND omission may understage patients for whom the distinction between stage IIIA and IIIB-C could alter adjuvant therapy recommendations. The aim of this study is to determine if stage migration has occurred with the declining use of CLND.
Patients with clinically node-negative ≥ T1b cutaneous melanoma were identified from the National Cancer Database (NCDB) from 2012 to 2018. CLND utilization and changes in AJCC staging were analyzed. Patients undergoing sentinel lymph node biopsy (SLNB) alone were compared with those undergoing SLNB + CLND.
Overall, 68,933 patients met inclusion criteria and 60,536 underwent SLNB, of which 9031 (14.9%) were tumor positive. CLND was performed in 3776 (41.8%). Patients undergoing CLND were younger (58 versus 62 years, p < 0.0001) and more likely male (61.5% versus 57.9%, p = 0.0005). Patients were more likely to have an N classification >N1a if they received SLNB + CLND (36.8%) versus SLNB alone (19.3%), p < 0.0001. This translated to a small difference in stage IIIA patients between groups (SLNB alone 34.0%, SLNB + CLND 31.8%, p < 0.0001). Of the patients with T1b/T2a tumors who would be upstaged from IIIA to IIIC with identification of additional positive nodes, IIIC incidence was only slightly higher after SLNB + CLND compared with SLNB alone (4.4% versus 1.1%, p < 0.0001). CLND utilization dramatically decreased from 59% in 2012 to 12.6% in 2018, p < 0.0001. However, the incidence of stage IIIA disease for all patients remained stable over the 7-year study period.
While the utilization of CLND after positive SLNB has declined dramatically in the last 7 years, stage migration that may affect adjuvant therapy decisions has not occurred to a clinically meaningful degree.
目前不再建议在黑色素瘤治疗中常规进行根治性淋巴结清扫术（CLND）。对于那些III A期和IIIB - C期的区分可能会改变辅助治疗建议的患者，不进行CLND可能会导致分期不准确。本研究的目的是确定随着CLND使用的减少是否发生了分期迁移。
从2012年至2018年的国家癌症数据库（NCDB）中识别出临床淋巴结阴性的≥T1b皮肤黑色素瘤患者。分析CLND的使用情况和美国癌症联合委员会（AJCC）分期的变化。将仅接受前哨淋巴结活检（SLNB）的患者与接受SLNB + CLND的患者进行比较。
总体而言，68933例患者符合纳入标准，60536例接受了SLNB，其中9031例（14.9%）肿瘤呈阳性。3776例（41.8%）进行了CLND。接受CLND的患者更年轻（58岁对62岁，p < 0.0001），男性比例更高（61.5%对57.9%，p = 0.0005）。与仅接受SLNB的患者（19.3%）相比，接受SLNB + CLND的患者更有可能出现N分期>N1a（36.8%），p < 0.
