Horisaki Ken, Yoshikawa Shusuke, Omata Wataru, Tsutsumida Arata, Kiyohara Yoshio
Department of Dermatology, Shizuoka Cancer Center, Shizuoka, Japan.
Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Dermatol. 2025 Jul;52(7):1152-1158. doi: 10.1111/1346-8138.17795. Epub 2025 May 23.
Sentinel lymph node biopsy (SLNB) has prognostic value in extramammary Paget's disease (EMPD) without lymph node enlargement; however, its therapeutic value is unknown. The likelihood of sentinel lymph node metastasis is extremely low, especially when the primary tumor is an intraepidermal lesion; therefore, sentinel node biopsy should not be performed in such cases. To avoid excessive sentinel node biopsy in patients with EMPD, we investigated the preoperative biomarkers that predict the degree of invasiveness of the primary tumor and sentinel lymph node metastasis. We reviewed 121 patients who underwent primary resection and SLNB. The invasion level of the primary tumor was intraepidermal in 50 patients (41.3%), microinvasion into the papillary dermis in 34 (28.1%), and deep invasion into/beyond the reticular dermis in 37 (30.6%). The sentinel node metastasis was positive in 0%, 5.9%, and 62.2% of patients in the intraepidermal, microinvasion, and deep invasion groups, respectively. Presence of nodules (odds ratio: 6.820, p = 0.001) and neutrophil-to-lymphocyte ratio (NLR) (≥ 3.03, odds ratio: 4.260, p = 0.009) were identified as independent predictive factors for deep dermal invasion of the primary tumor and sentinel node metastasis (with nodules, odds ratio: 8.460, p < 0.001 and NLR ≥ 2.87, odds ratio: 3.870, p = 0.016). The metastasis-positive group had a significantly lower overall survival than the negative group (median overall survival: 27.6 months vs. not reached, log-rank test, p < 0.001). In conclusion, routine SLNB may be useful for predicting the prognosis of patients with EMPD without clinical lymph node enlargement. However, the likelihood of sentinel lymph node metastasis is extremely low in intraepidermal and microinvasive primary lesions. It may be reasonable to proactively recommend SLNB, particularly in cases with confirmed deep invasion lesions, the presence of nodules, or elevated NLR.
前哨淋巴结活检（SLNB）对无淋巴结肿大的乳腺外佩吉特病（EMPD）具有预后价值；然而，其治疗价值尚不清楚。前哨淋巴结转移的可能性极低，尤其是当原发性肿瘤为表皮内病变时；因此，在这种情况下不应进行前哨淋巴结活检。为避免EMPD患者进行过度的前哨淋巴结活检，我们研究了术前生物标志物，这些标志物可预测原发性肿瘤的侵袭程度和前哨淋巴结转移情况。我们回顾了121例行原发性切除和SLNB的患者。原发性肿瘤的侵袭水平在50例患者（41.3%）中为表皮内，在34例（28.1%）中为微侵袭至乳头真皮层，在37例（30.6%）中为深侵袭至网状真皮层及更深部位。前哨淋巴结转移在表皮内、微侵袭和深侵袭组患者中的阳性率分别为0%、5.9%和62.2%。结节的存在（比值比：6.820，p = 0.001）和中性粒细胞与淋巴细胞比值（NLR）（≥ 3.03，比值比：4.260，p = 0.009）被确定为原发性肿瘤深真皮层侵袭和前哨淋巴结转移的独立预测因素（有结节时，比值比：8.460，p < 0.001；NLR≥ 2.87，比值比：3.870，p = 0.016）。转移阳性组的总生存期显著低于阴性组（中位总生存期：27.6个月对未达到，对数秩检验，p < 0.001）。总之，常规SLNB可能有助于预测无临床淋巴结肿大的EMPD患者的预后。然而，表皮内和微侵袭性原发性病变的前哨淋巴结转移可能性极低。对于确诊为深侵袭性病变、有结节或NLR升高的病例，积极推荐SLNB可能是合理的。
