Roccuzzo Gabriele, Macagno Nicole, Grignani Pietro, Astrua Chiara, Brizio Matteo Giovanni, Cavaliere Giovanni, Picciotto Franco, Caliendo Virginia, Fruttero Enrico, Ribero Simone, Fava Paolo, Quaglino Pietro
Department of Medical Sciences, Section of Dermatology, University of Turin, 10126 Turin, Italy.
Department of Surgery, Dermatologic Surgery Section, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, 10126 Turin, Italy.
J Clin Med. 2024 Sep 4;13(17):5238. doi: 10.3390/jcm13175238.
Advancements in managing stage III melanoma have involved the implementation of adjuvant therapies alongside a simultaneous decrease in the utilization of completion lymph node dissection (CLND) following positive sentinel node biopsy (SLNB). This retrospective study from the University of Turin's Dermatology Clinic analyzed relapse-free survival (RFS) and overall survival (OS) among stage III melanoma patients (n = 157) who underwent CLND after positive SLNB versus those who did not receive such procedure. Patients without CLND had a median RFS of 49 months (95% CI 42-NA), while CLND recipients showed 51 months (95% CI 31-NA) ( = 0.139). The 48-month OS for non-CLND patients was 79.8% (95% CI 58.2-91.0) versus 79.2% (95% CI 67.5-87.0) for CLND recipients ( = 0.463). Adjusted Hazard Ratios through inverse probability treatment weighting revealed the impact of CLND to be insignificant on RFS (aHR 0.90, 95% CI 0.37-2.22) and marginal on OS (aHR 0.41, 95% CI 0.13-1.21). Conversely, adjuvant therapy significantly reduced the risk of relapse (aHR 0.46, 95% CI 0.25-0.84), irrespective of CLND. : This study corroborates the growing evidence that CLND after positive SLNB does not enhance RFS or OS, while emphasizing the crucial role of adjuvant therapy, be it immunotherapy or targeted therapy, in reducing the risk of relapse in melanoma patients with positive SLNB.
III期黑色素瘤管理方面的进展包括实施辅助治疗，同时在前哨淋巴结活检（SLNB）呈阳性后，完成淋巴结清扫术（CLND）的使用率有所下降。都灵大学皮肤科诊所的这项回顾性研究分析了SLNB呈阳性后接受CLND的III期黑色素瘤患者（n = 157）与未接受该手术的患者的无复发生存期（RFS）和总生存期（OS）。未进行CLND的患者的中位RFS为49个月（95%CI 42 - NA），而接受CLND的患者为51个月（95%CI 31 - NA）（P = 0.139）。未进行CLND的患者48个月的OS为79.8%（95%CI 58.2 - 91.0），而接受CLND的患者为79.2%（95%CI 67.5 - 87.0）（P = 0.463）。通过逆概率治疗加权调整后的风险比显示，CLND对RFS的影响不显著（aHR 0.90，95%CI 0.37 - 2.22），对OS的影响微乎其微（aHR 0.41，95%CI 0.13 - 1.21）。相反，辅助治疗显著降低了复发风险（aHR 0.46，95%CI 0.25 - 0.84），无论是否进行CLND。这项研究证实了越来越多的证据表明，SLNB呈阳性后进行CLND并不能提高RFS或OS，同时强调了辅助治疗（无论是免疫治疗还是靶向治疗）在降低SLNB呈阳性的黑色素瘤患者复发风险方面的关键作用。
