Jiminez Victoria, Montgomery Kelsey B, Hollenquest Britany, Broman Kristy K
Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Am J Surg. 2025 Jan;239:116049. doi: 10.1016/j.amjsurg.2024.116049. Epub 2024 Oct 29.
The Second Multicenter Selective Lymphadenectomy Trial (MSLT-II), published in 2017, demonstrated equivalent melanoma-specific survival between nodal surveillance and completion lymph node dissection (CLND) for sentinel lymph node (SLN) positive melanoma. This study evaluated outcomes of nodal surveillance in an early post-MSLT-II institutional cohort.
Included patients received nodal surveillance from 2017 to 2023. Primary outcomes were nodal basin and any site recurrence. Kaplan Meier curves and Cox proportional hazard models were used to evaluate recurrence-free survial and associated factors.
This 212 patient cohort (median age 61 years, 57.7 % male, 96.7 % white) had median primary tumor depth of 1.9 mm and one positive SLN. Sixty-three patients (29.7 %) recurred at 23 month median follow-up. Sixty percent received adjuvant therapy. Any site and nodal basin recurrence-free survival were 58.3 % and 80.9 % at 3 years. On adjusted analysis, older age and head/neck primary site were associated with worse recurrence-free survival.
Long-term outcomes at a single institution were comparable to clinical trial findings. Nodal surveillance remains a feasible management strategy for SLN + melanoma.
2017年发表的第二项多中心选择性淋巴结清扫试验（MSLT-II）表明，对于前哨淋巴结（SLN）阳性的黑色素瘤，淋巴结监测与根治性淋巴结清扫术（CLND）的黑色素瘤特异性生存率相当。本研究评估了MSLT-II后早期机构队列中淋巴结监测的结果。
纳入的患者在2017年至2023年期间接受淋巴结监测。主要结局为淋巴结区域和任何部位的复发。采用Kaplan-Meier曲线和Cox比例风险模型评估无复发生存率及相关因素。
该队列共212例患者（中位年龄61岁，57.7%为男性，96.7%为白人），原发肿瘤中位深度为1.9mm，1枚SLN阳性。在中位随访23个月时，63例患者（29.7%）出现复发。60%的患者接受了辅助治疗。3年时任何部位和淋巴结区域的无复发生存率分别为58.3%和80.9%。经校正分析，年龄较大和头颈部原发部位与较差的无复发生存率相关。
单一机构的长期结局与临床试验结果相当。淋巴结监测仍然是SLN阳性黑色素瘤的一种可行管理策略。
