Surgeon decision-making for management of positive sentinel lymph nodes in the post-Multicenter Selective Lymphadenectomy Trial II era: A survey study.
Surgeon decision-making for management of positive sentinel lymph nodes in the post-Multicenter Selective Lymphadenectomy Trial II era: A survey study.
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多中心选择性淋巴结切除术后II期阳性前哨淋巴结处理的外科医生决策：一项调查研究。
DOI：
10.1002/jso.26302
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发表时间：
2021-03
影响因子：
2.5
通讯作者：
Zager JS
中科院分区：
文献类型：
--
作者：
Hui JYC;Burke E;Broman KK;Marmor S;Jensen E;Tuttle TM;Zager JS
在第二次多中心选择性淋巴切除术试验(MSLT-II)中，完成淋巴清扫术(CLND)并没有改善前哨淋巴结(SLN)阳性黑色素瘤患者的特定黑色素瘤生存率。我们评估了外科医生对MSLT-II的认识及其对CLND建议的影响。外科肿瘤学会会员的一项匿名在线横断面调查根据患者情景和临床病理特征排名评估了外科医生提供CLND的门槛。在发送的2881封电子邮件中，146名外科医生(5.1%)完成了所有七种情况。大多数人(129/131，98%)知道MSLT-II，125(95%)发现它改变了做法。具体来说，52%(125人中的65人)总是提供CLND，40%通常，6%很少，3%在MSLT-II之前从未提供过CLND。与此同时，在MSLT-II(p<；0.0001)之后，4%的人总是提供CLND，9%的人通常提供，78%的人很少，8%的人从来不提供CLND。决定CLND建议的最重要的临床病理因素是包膜外侵犯、SLN阳性数目和SLN肿瘤沉积大小，而原发肿瘤有丝分裂指数和结节盆位置最不重要。外科肿瘤学奖学金培训、黑色素瘤患者数量和学术中心实践也影响了CLND的建议。大多数外科医生受访者都知道MSLT-II，但其在实践中的应用因几个临床病理和外科医生因素而异。
Completion lymph node dissection (CLND) did not improve melanoma-specific survival for patients with sentinel lymph node (SLN) positive melanoma in the second Multicenter Selective Lymphadenectomy Trial (MSLT-II). We assessed surgeons’ awareness of MSLT-II and its impact on CLND recommendations. An anonymous online cross-sectional survey of the Society of Surgical Oncology membership evaluated surgeon thresholds in offering CLND using patient scenarios and clinicopathologic characteristics ranking. Of the 2881 e-mails delivered, 146 surgeons (5.1%) completed all seven scenarios. Most (129 of 131, 98%) were aware of MSLT-II and 125 (95%) found it practice-changing. Specifically, 52% (65 of 125) always, 40% usually, 6% rarely, and 3% never offered CLND prior to MSLT-II. Meanwhile, 4% always, 9% usually, 78% rarely, and 8% never offer CLND now, after MSLT-II (p<0.0001). The most important clinicopathologic factors in determining CLND recommendations were extracapsular extension, number of positive SLN and SLN tumor deposit size, while primary tumor mitotic index and nodal basin location were the least important. Surgical oncology fellowship training, melanoma patient volume and academic center practice also influenced CLND recommendations. Most surgeon respondents are aware of MSLT-II, but its application in practice varies according to several clinicopathologic and surgeon factors.
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DOI：
10.1056/nejmoa1613210
发表时间：
2017-06-08
期刊：
The New England journal of medicine
影响因子：
--
作者：
Faries MB;Thompson JF;Cochran AJ;Andtbacka RH;Mozzillo N;Zager JS;Jahkola T;Bowles TL;Testori A;Beitsch PD;Hoekstra HJ;Moncrieff M;Ingvar C;Wouters MWJM;Sabel MS;Levine EA;Agnese D;Henderson M;Dummer R;Rossi CR;Neves RI;Trocha SD;Wright F;Byrd DR;Matter M;Hsueh E;MacKenzie-Ross A;Johnson DB;Terheyden P;Berger AC;Huston TL;Wayne JD;Smithers BM;Neuman HB;Schneebaum S;Gershenwald JE;Ariyan CE;Desai DC;Jacobs L;McMasters KM;Gesierich A;Hersey P;Bines SD;Kane JM;Barth RJ;McKinnon G;Farma JM;Schultz E;Vidal-Sicart S;Hoefer RA;Lewis JM;Scheri R;Kelley MC;Nieweg OE;Noyes RD;Hoon DSB;Wang HJ;Elashoff DA;Elashoff RM
通讯作者：
Elashoff RM
影响因子：
--
作者：
DeFazio, Jennifer L.;Marghoob, Ashfaq A.;Halpern, Allan
通讯作者：
Halpern, Allan
影响因子：
51.1
作者：
Leiter, Ulrike;Stadler, Rudolf;Garbe, Claus
通讯作者：
Garbe, Claus
影响因子：
3.7
作者：
Rossi, Carlo Riccardo;Mocellin, Simone;Ribero, Simone
通讯作者：
Ribero, Simone
影响因子：
3.7
作者：
Wong, Sandra L.;Balch, Charles M.;Lyman, Gary H.
通讯作者：
Lyman, Gary H.