The prognostic significance of non-sentinel lymph node metastasis in cutaneous and acral melanoma patients-A multicenter retrospective study.
The prognostic significance of non-sentinel lymph node metastasis in cutaneous and acral melanoma patients-A multicenter retrospective study.
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皮肤和肢端黑色素瘤非前哨淋巴结转移的预后意义——多中心回顾性研究
DOI：
10.1002/cac2.12101
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Chen Y
中科院分区：
文献类型：
--
作者：
Sun W;Xu Y;Yang J;Liao Z;Li T;Huang K;Patel P;Yan W;Chen Y
非前哨淋巴结(SLN)阳性黑色素瘤患者是否可以从完全淋巴清扫术(CLND)中受益仍不清楚。本研究旨在明确SLN阳性黑色素瘤患者中非SLN状态对预后的影响，并探讨肢端和皮肤黑色素瘤患者非SLN转移的预测因素。回顾了2009年9月至2017年8月在四个癌症中心接受根治性手术的328名SLN阳性黑色素瘤患者的记录。包括年龄、性别、Clark分级、Breslow指数、溃疡、SLN阳性数目、非SLN状态和辅助治疗等临床病理资料用于生存分析。患者被随访到死亡或2019年6月30日。采用多变量Logistic回归模型来确定与非SLN阳性相关的因素。采用对数秩数分析和COX回归分析确定影响无瘤生存期(DFS)和总生存期(OS)的预后因素。在所有入选的患者中，220例(67.1%)为肢端黑色素瘤，108例(32.9%)为皮肤黑色素瘤。整个队列的5年DFS和OS率分别为31.5%和54.1%。123例(37.5%)SLN阳性>1例。非SLN阳性99例(30.2%)。非SLN阳性患者的DFS和OS明显更差(对数等级P<0.001)。非SLN状态(P=0.003)、SLN阳性数目(P=0.016)、辅助治疗(P=0.025)是影响DFS预后的独立因素；非SLN状态(P=0.002)、Breslow指数(P=0.027)、Clark水平(P=0.006)、溃烂(P=0.004)、SLN阳性数目(P=0.001)、辅助治疗(P=0.007)是OS的独立预后因素。Breslow指数(P=0.020)、Clark分级(P=0.012)、SLN阳性数目(P=0.031)与非SLN阳性独立相关，可用于制定更个性化的手术策略。即使在即刻CLND后，非SLN阳性黑色素瘤患者的DFS和OS也比那些非SLN阴性黑色素瘤患者差。Breslow指数、Clark水平和SLN阳性数目是非SLN状态的独立预测因素。
Whether non‐sentinel lymph node (SLN)‐positive melanoma patients can benefit from completion lymph node dissection (CLND) is still unclear. The current study was performed to identify the prognostic role of non‐SLN status in SLN‐positive melanoma and to investigate the predictive factors of non‐SLN metastasis in acral and cutaneous melanoma patients. The records of 328 SLN‐positive melanoma patients who underwent radical surgery at four cancer centers from September 2009 to August 2017 were reviewed. Clinicopathological data including age, gender, Clark level, Breslow index, ulceration, the number of positive SLNs, non‐SLN status, and adjuvant therapy were included for survival analyses. Patients were followed up until death or June 30, 2019. Multivariable logistic regression modeling was performed to identify factors associated with non‐SLN positivity. Log‐rank analysis and Cox regression analysis were used to identify the prognostic factors for disease‐free survival (DFS) and overall survival (OS). Among all enrolled patients, 220 (67.1%) had acral melanoma and 108 (32.9%) had cutaneous melanoma. The 5‐year DFS and OS rate of the entire cohort was 31.5% and 54.1%, respectively. More than 1 positive SLNs were found in 123 (37.5%) patients. Positive non‐SLNs were found in 99 (30.2%) patients. Patients with positive non‐SLNs had significantly worse DFS and OS (log‐rank P < 0.001). Non‐SLN status (P = 0.003), number of positive SLNs (P = 0.016), and adjuvant therapy (P = 0.025) were independent prognostic factors for DFS, while non‐SLN status (P = 0.002), the Breslow index (P = 0.027), Clark level (P = 0.006), ulceration (P = 0.004), number of positive SLNs (P = 0.001), and adjuvant therapy (P = 0.007) were independent prognostic factors for OS. The Breslow index (P = 0.020), Clark level (P = 0.012), and number of positive SLNs (P = 0.031) were independently related to positive non‐SLNs and could be used to develop more personalized surgical strategy. Non‐SLN‐positive melanoma patients had worse DFS and OS even after immediate CLND than those with non‐SLN‐negative melanoma. The Breslow index, Clark level, and number of positive SLNs were independent predictive factors for non‐SLN status.
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影响因子：
--
作者：
Bradford, Porcia T.;Goldstein, Alisa M.;McMaster, Mary L.;Tucker, Margaret A.
通讯作者：
Tucker, Margaret A.
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：
158.5
作者：
Long, G. V.;Hauschild, A.;Kirkwood, J. M.
通讯作者：
Kirkwood, J. M.
影响因子：
51.1
作者：
Leiter, Ulrike;Stadler, Rudolf;Garbe, Claus
通讯作者：
Garbe, Claus
影响因子：
9
作者：
Morton, DL;Cochran, AJ;Wang, HJ
通讯作者：
Wang, HJ