Weitemeyer Marie B, Helvind Neel M, Klausen Siri, Clasen-Linde Erik, Schmidt Grethe, Chakera Annette H, Hölmich Lisbet R
Department of Plastic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.
Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.
J Surg Oncol. 2025 Sep;132(3):447-455. doi: 10.1002/jso.70035. Epub 2025 Jul 7.
Sentinel lymph node biopsy (SLNB) is crucial for staging and managing melanoma, but selecting patients for SLNB is challenging, with around 80% of procedures yielding negative results. The clinicopathological and gene expression profile model (CP-GEP) was developed to identify low-risk melanoma patients who may forgo SLNB. CP-GEP combines Breslow thickness, patient age, and a gene expression analysis to classify patients as high- or low-risk for nodal metastasis. This study aimed to validate the performance of CP-GEP in a multicenter Danish cohort.
Primary melanoma tissue from 536 T1-T3 patients who had undergone SLNB was retrospectively analyzed using CP-GEP. Results were compared with SLNB status and the Melanoma Institute Australia nomogram (MIA).
T1, T2, and T3 melanomas comprised 32.8%, 46.8%, and 20.3% of cases, respectively. The SLNB positivity rate was 18.1%. Overall, 40.9% was classified as CP-GEP low-risk (NPV 91.3%). Among T1 and T2 subgroups, 72.7% and 35.5% were low-risk, with NPVs of 94.5% and 87.6%, respectively. For 507 patients with MIA scores, CP-GEP identified 42.4% as low-risk (NPV 91.2%) versus 8.1% by MIA (NPV 95.1%).
CP-GEP is a promising tool for supporting deselection of SLNB in melanoma patients, with a potential reduction rate of over 40%.
前哨淋巴结活检（SLNB）对于黑色素瘤的分期和治疗至关重要，但选择进行SLNB的患者具有挑战性，约80%的手术结果为阴性。临床病理和基因表达谱模型（CP-GEP）旨在识别可能无需进行SLNB的低风险黑色素瘤患者。CP-GEP结合Breslow厚度、患者年龄和基因表达分析，将患者分为淋巴结转移的高风险或低风险。本研究旨在验证CP-GEP在丹麦多中心队列中的性能。
对536例接受SLNB的T1-T3期患者的原发性黑色素瘤组织进行回顾性CP-GEP分析。将结果与SLNB状态和澳大利亚黑色素瘤研究所列线图（MIA）进行比较。
T1、T2和T3期黑色素瘤分别占病例的32.8%、46.8%和20.3%。SLNB阳性率为18.1%。总体而言，40.9%被分类为CP-GEP低风险（阴性预测值91.3%）。在T1和T2亚组中，72.7%和35.5%为低风险，阴性预测值分别为94.5%和87.6%。对于507例有MIA评分的患者，CP-GEP将42.4%识别为低风险（阴性预测值91.2%），而MIA识别为8.1%（阴性预测值95.1%）。
CP-GEP是支持黑色素瘤患者不进行SLNB选择的有前景的工具，潜在减少率超过40%。
