Fortner J G, Woodruff J, Schottenfeld D, Maclean B
Ann Surg. 1977 Jul;186(1):101-3. doi: 10.1097/00000658-197707000-00014.
During the years 1954 through 1964, 259 individuals with primary malignant melanoma had an elective node dissection. Microscopic metastases were found in 15% of these patients. The presence of only a microscopic focus of involvement gave a 10-year cure rate of 67%; metastasis larger than a microscopic focus in a single node, 50%; and more than one node, 15%. One hundred forty-five individuals were treated by wide excision alone with 18% subsequently requiring a therapeutic lymphadenectomy with a ten-year cure of only 6%. A prospective study was then initiated which was concerned with efficacy of selection of patients for elective node dissection. Clark's level of invasion was determined for 258 patients treated since January 1972. The depth of invasion of the primary lesion was found to correlate directly with the absence of lymph node metastases, extent of nodal involvement, and rate of recurrence. It is concluded that the concept of elective node dissection is valid.
在1954年至1964年期间，259例原发性恶性黑色素瘤患者接受了选择性淋巴结清扫术。其中15%的患者发现有微小转移灶。仅存在微小受累灶的患者10年治愈率为67%；单个淋巴结中转移灶大于微小病灶的患者治愈率为50%；多个淋巴结受累的患者治愈率为15%。145例患者仅接受了广泛切除术，其中18%的患者随后需要进行治疗性淋巴结清扫术，其10年治愈率仅为6%。随后开展了一项前瞻性研究，关注选择性淋巴结清扫术患者选择的有效性。对自1972年1月以来接受治疗的258例患者确定了克拉克侵袭水平。发现原发性病变的侵袭深度与无淋巴结转移、淋巴结受累程度和复发率直接相关。结论是选择性淋巴结清扫术的概念是有效的。
