黑色素瘤患者前哨淋巴结活检阳性后完成淋 巴结切除术的时机。
Timing of completion lymphadenectomy after positive sentinel node biopsy in patients with melanoma.
机构信息
Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Department of Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
出版信息
Br J Surg. 2017 May;104(6):726-733. doi: 10.1002/bjs.10475. Epub 2017 Feb 20.
BACKGROUND
Nodal staging with sentinel node biopsy (SNB) and completion lymph node dissection (CLND) provides prognostic information to patients with melanoma and their physicians. It is not known whether the timing of CLND is associated with survival outcome and/or CLND tumour load. This study investigated whether CLND timing is associated with CLND tumour load, disease-free survival (DFS) and/or melanoma-specific survival (MSS).
METHODS
A retrospective cohort of patients with SNB-positive melanoma from nine European Organisation for Research and Treatment of Cancer (EORTC) Melanoma Group centres undergoing surgery between 1993 and 2009 were examined. Patients were selected based on availability of CLND and follow-up data. The CLND interval was defined as the number of days between diagnosis and CLND. Patient and tumour characteristics were collected. Five-year DFS and MSS rates were calculated. Cox and logistic regression analysis were performed, adjusting for known prognostic/predictive indicators.
RESULTS
A total of 784 patients were included in the study. Their median age was 51 (i.q.r. 40-62) years, and 418 patients (53·3 per cent) were men. Median Breslow thickness was 3·0 (i.q.r. 2·0-5·0) mm, and 148 patients (18·9 per cent) had a residual tumour load. Median CLND interval was 84 (i.q.r. 65-105) days. Five-year DFS and MSS rates were not significantly different for patients operated on with a median CLND interval of less than 84 days and those with an interval of at least 84 days (DFS: 54·2 versus 53·3 per cent respectively; MSS: 66·9 versus 65·1 per cent). In a multivariable Cox model, CLND interval was not a significant prognostic indicator. CLND interval was negatively correlated with identification of positive non-sentinel nodes, but following adjustment for known risk factors this effect was no longer found.
CONCLUSION
The time interval between diagnosis of melanoma and CLND did not influence CLND tumour load, DFS or MSS.
背景
前哨淋巴结活检（SNB）和完成淋巴结清扫（CLND）的淋巴结分期为黑色素瘤患者及其医生提供了预后信息。目前尚不清楚 CLND 的时机是否与生存结果和/或 CLND 肿瘤负荷有关。本研究调查了 CLND 时机是否与 CLND 肿瘤负荷、无病生存率（DFS）和/或黑色素瘤特异性生存率（MSS）有关。
方法
本研究回顾性分析了 1993 年至 2009 年间欧洲癌症研究与治疗组织（EORTC）黑色素瘤组 9 个中心进行 SNB 阳性黑色素瘤手术的患者。选择患者的依据是 CLND 和随访数据的可用性。CLND 间隔定义为诊断与 CLND 之间的天数。收集患者和肿瘤特征。计算 5 年 DFS 和 MSS 率。进行 Cox 和逻辑回归分析，并调整已知的预后/预测指标。
结果
本研究共纳入 784 例患者。患者的中位年龄为 51（四分位距 40-62）岁，418 例（53.3%）为男性。中位 Breslow 厚度为 3.0（四分位距 2.0-5.0）mm，148 例（18.9%）有残留肿瘤负荷。CLND 间隔的中位数为 84（四分位距 65-105）天。5 年 DFS 和 MSS 率在 CLND 间隔小于 84 天的患者和间隔大于或等于 84 天的患者之间无显著差异（DFS：54.2%和 53.3%；MSS：66.9%和 65.1%）。在多变量 Cox 模型中，CLND 间隔不是一个显著的预后指标。CLND 间隔与识别阳性非前哨淋巴结呈负相关，但在调整已知危险因素后，这种影响不再存在。
结论
黑色素瘤诊断与 CLND 之间的时间间隔不会影响 CLND 肿瘤负荷、DFS 或 MSS。
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