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首页> 外文期刊>Annals of surgical oncology >Role for lymphatic mapping and sentinel lymph node biopsy in patients with thick (> or = 4 mm) primary melanoma.
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Role for lymphatic mapping and sentinel lymph node biopsy in patients with thick (> or = 4 mm) primary melanoma.

机译：厚（>或= 4 mm）原发性黑色素瘤患者的淋巴标测和前哨淋巴结活检的作用。

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BACKGROUND: Historically, patients with thick (> or =4 mm) primary melanoma have not been considered candidates for elective lymph node dissection, because their risk for occult distant disease is significant. Sentinel lymph node (SLN) biopsy offers an alternative approach to assess disease in the regional nodal basin, but no studies have specifically addressed the role for this technique in patients with thick melanoma. Although adjuvant therapy benefits patients who develop nodal metastases, data that supports its routine use in all patients with thick melanoma is both limited and controversial. This study was performed to determine whether pathological status of the SLN is an important risk factor in this heterogeneous group and, thus, provides a rationale for SLN biopsy. METHODS: The records of 131 patients with primary cutaneous melanoma whose primary tumors were at least 4 mm thick and who underwent lymphatic mapping and SLN biopsy were reviewed. Several known prognostic factors, i.e., tumor thickness, ulceration, Clark level, location, sex, as well as SLN pathological status were analyzed with respect to disease-free and overall survival. RESULTS: Lymphatic mapping and SLN biopsy was successful in 126 (96%) of 131 patients who underwent the procedure. In 49 patients (39%), the SLN biopsy was positive by conventional histology, although it was negative in 77 patients (61%). The median follow-up was 3 years. Although presence of ulceration and SLN status were independent prognostic factors with respect to disease-free and overall survival, SLN status was the most powerful predictor of overall survival by univariate and multivariate analyses. CONCLUSIONS: Lymphatic mapping and SLN biopsy is a highly accurate method of staging lymph node basins at risk for regional metastases in patients with thick melanoma and identifies those patients who may benefit from earlier lymphadenectomy as well as patients with a more favorable prognosis. Pathological status of the SLN in these patients with clinically negative nodes is the most important prognostic factor for survival and is essential to establish stratification criteria for future adjuvant trials in this high-risk group.
机译：背景：从历史上看，原发性黑色素瘤较厚（>或= 4 mm）的患者由于其隐匿性远距离疾病的风险很高，因此并未被视为选择性淋巴结清扫术的候选人。前哨淋巴结（SLN）活检为评估区域淋巴结疾病提供了另一种方法，但尚无研究专门针对这种技术在厚性黑色素瘤患者中的作用。尽管辅助治疗有益于发生淋巴结转移的患者，但支持其在所有厚黑色素瘤患者中常规使用的数据既有限，也有争议。进行这项研究是为了确定SLN的病理状态是否是这一异质性组中的重要危险因素，从而为SLN活检提供了依据。方法：对131例原发性皮肤黑素瘤患者的病史进行了回顾性分析，这些患者的原发性肿瘤厚度至少为4 mm，并进行了淋巴标本和SLN活检。就无病生存期和总生存期，分析了几种已知的预后因素，即肿瘤厚度，溃疡，克拉克水平，位置，性别以及SLN病理状态。结果：131例接受该手术的患者中有126例（96％）成功进行了淋巴定位和SLN活检。按常规组织学检查，在49例患者（39％）中，SLN活检为阳性，尽管77例患者（61％）为阴性。中位随访时间为3年。尽管溃疡的发生和SLN的状态是无病生存和总体生存的独立预后因素，但是通过单因素和多因素分析，SLN的状态是整体生存的最有力预测指标。结论：淋巴图和SLN活检是一种高度准确的方法，可将厚黑色素瘤患者的区域淋巴结转移风险转移到淋巴结中，并识别出那些可能从早期淋巴结清扫术中受益的患者以及预后更佳的患者。这些具有临床阴性淋巴结转移的患者中SLN的病理状态是生存的最重要预后因素，对于建立该高风险组未来辅助试验的分层标准至关重要。

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