用于预测黑色素瘤前哨淋巴结转移的临床病理和基因表达模型的验证：一项丹麦多中心队列研究
Validation of a Clinicopathologic and Gene Expression Model for Predicting Sentinel Node Metastasis in Melanoma: A Multicenter Danish Cohort Study.
作者信息
Weitemeyer Marie B, Helvind Neel M, Klausen Siri, Clasen-Linde Erik, Schmidt Grethe, Chakera Annette H, Hölmich Lisbet R
机构信息
Department of Plastic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.
Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.
出版信息
J Surg Oncol. 2025 Sep;132(3):447-455. doi: 10.1002/jso.70035. Epub 2025 Jul 7.
BACKGROUND
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.
METHOD
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).
RESULTS
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%).
CONCLUSION
CP-GEP is a promising tool for supporting deselection of SLNB in melanoma patients, with a potential reduction rate of over 40%.
背景
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。
方法
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。
结果
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%）。
结论
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%。
Zotero 插件