Incidence of sentinel node metastasis in patients with thin primary melanoma (≤1 mm) with vertical growth phase
Incidence of sentinel node metastasis in patients with thin primary melanoma (≤1 mm) with vertical growth phase
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DOI：
10.1007/s10434-000-0262-z
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发表时间：
2000-05-01
影响因子：
3.7
通讯作者：
Czerniecki, BJ
中科院分区：
文献类型：
--
作者：
Bedrosian, I;Faries, MB;Czerniecki, BJ
背景：原发性黑色素瘤较薄（小于或等于 1 毫米）的患者通常预后良好。然而，垂直生长期（VGP）的存在会对存活率产生不利影响。我们报告了接受前哨淋巴结 (SLN) 活检的薄原发性黑色素瘤 VGP 患者的淋巴结转移发生率。 方法：在 235 名成功接受 SLN 活检的临床局限性皮肤黑色素瘤患者中，71 例接受 VGP 病变为 1 毫米或更小。使用蓝色染料和放射性示踪剂对前哨淋巴结进行定位。如果苏木精和伊红染色阴性，则进一步进行免疫组织化学检查SLN。结果：深度大于1mm的黑色素瘤患者SLN转移发生率为15.2%，薄黑色素瘤患者SLN转移发生率为5.6%。根据用于预测 I/II 期黑色素瘤 8 年生存的高精度六变量多元 Logistic 回归模型，三名薄黑色素瘤且 SLN 阳性的患者具有低风险病变。根据该模型，第四名患者具有低至中风险病变。在淋巴结切除术时，一名患者有两个额外的淋巴结转移。结论：1毫米或更小的黑色素瘤中的VGP似乎是淋巴结转移的危险因素。使用包含厚度、有丝分裂率、回归、肿瘤浸润淋巴细胞、性别和解剖部位的多元逻辑回归模型可能无法准确预测淋巴结疾病的风险。患有 VGP 的薄病灶患者应进行 SLN 活检评估，并在发现 III 期疾病时进行辅助治疗试验。
Background: Patients with thin primary melanomas (less than or equal to 1 mm) generally have an excellent prognosis. However, the presence of a vertical growth phase (VGP) adversely impacts the survival rate. We report on the rate of occurrence of nodal metastasis in patients with thin primary melanomas with a VGP who are offered sentinel lymph node (SLN) biopsy.Methods: Among 235 patients with clinically localized cutaneous melanomas who underwent successful SLN biopsy, 71 had lesions 1 mm or smaller with a VGP. The SLN was localized by using blue dye and a radiotracer. If negative for tumor by using hematoxylin and eosin staining, the SLN was further examined by immunohistochemistry.Results: The rate of occurrence of SLN metastasis was 15.2% in patients with melanomas deeper than 1 mm and 5.6% in patients with thin melanomas. Three patients with thin melanomas and a positive SLN had low-risk lesions, based on a highly accurate six-variable multivariate logistic regression model for predicting 8-year survival in stage I/II melanomas. The fourth patient had a low- to intermediate-risk lesion based on this model. At the time of the lymphadenectomy, one patient had two additional nodes with metastasis.Conclusions: VGP in a melanoma 1 mm or smaller seems to be a risk factor for nodal metastasis. The risk of nodal disease may not be accurately predicted by the use of a multivariate logistic regression model that incorporates thickness, mitotic rate, regression, tumor-infiltrating lymphocytes, sex, and anatomical site. Patients with thin lesions having VGP should be evaluated for SLN biopsy and trials of adjuvant therapy when stage III disease is found.