Stassen Robert C, Schurink Antonius W, van der Veldt Astrid A M, Hollestein Loes M, Verhoef Cornelis, Grünhagen Dirk J
Department of Surgical Oncology, Erasmus Medical Centre Cancer Institute, Rotterdam, the Netherlands.
Department of Medical Oncology, Erasmus Medical Centre Cancer Institute, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Centre Cancer Institute, Rotterdam, the Netherlands.
Eur J Cancer. 2025 May 2;220:115365. doi: 10.1016/j.ejca.2025.115365. Epub 2025 Apr 1.
Sentinel lymph node biopsy (SLNB) aims to stage patients. According to the 8th edition of the American Joint Committee on Cancer(AJCC) staging manual, patients with pT1b or pT2a melanoma can be eligible for adjuvant immunotherapy, however, only if they have a sentinel node (SN) tumour burden > 1 mm. This study aims to determine the percentage of patients with pT1b or pT2a that will become eligible for adjuvant immunotherapy following SLNB.
A nationwide, population-based study was conducted using data from the Dutch Pathology Databank. Patients diagnosed with pT1b and pT2a melanoma between 2002 and 2023 were included. The primary endpoint was the number of SNs with a tumour burden > 1 mm.
We identified 36,606 patients of who 16,042 underwent SLNB. SN positivity was 5 % for patients with pT1b melanoma, and 11 % for pT2a melanoma. A tumour burden > 1 mm was found in 1.5 % and 4.1 %, translating to a number needed to treat (NNT) of 69 for pT1b and 25 for pT2a.
This nationwide study demonstrated a low incidence of positive SNs and minimal likelihood of significant clinical outcomes following SLNB. Given the high NNT to be eligible for adjuvant immunotherapy, SLNB may no longer be justified for pT1b melanoma. For patients with pT2a melanoma, SLNB should be considered carefully, balancing limited clinical benefits against potential risks.
前哨淋巴结活检（SLNB）旨在对患者进行分期。根据美国癌症联合委员会（AJCC）第8版分期手册，pT1b或pT2a期黑色素瘤患者有资格接受辅助免疫治疗，但前提是他们的前哨淋巴结（SN）肿瘤负荷>1mm。本研究旨在确定pT1b或pT2a期患者在进行SLNB后有资格接受辅助免疫治疗的比例。
利用荷兰病理数据库的数据进行了一项全国性的基于人群的研究。纳入了2002年至2023年间诊断为pT1b和pT2a期黑色素瘤的患者。主要终点是肿瘤负荷>1mm的前哨淋巴结数量。
我们确定了36606例患者，其中16042例接受了SLNB。pT1b期黑色素瘤患者的前哨淋巴结阳性率为5%，pT2a期黑色素瘤患者为11%。肿瘤负荷>1mm的比例分别为1.5%和4.1%，这意味着pT1b期的治疗所需例数（NNT）为69，pT2a期为25。
这项全国性研究表明，SLNB后前哨淋巴结阳性的发生率较低，出现显著临床结果的可能性极小。鉴于接受辅助免疫治疗的NNT较高，对于pT1b期黑色素瘤，SLNB可能不再合理。对于pT2a期黑色素瘤患者，应仔细考虑SLNB，权衡有限的临床益处与潜在风险。
