Predictors and natural history of in-transit melanoma after sentinel lymphadenectomy
Predictors and natural history of in-transit melanoma after sentinel lymphadenectomy
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DOI：
10.1245/aso.2005.05.025
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发表时间：
2005-08-01
影响因子：
3.7
通讯作者：
Gershenwald, JE
中科院分区：
文献类型：
--
作者：
Pawlik, TM;Ross, MI;Gershenwald, JE
背景：转移中复发是黑色素瘤患者治疗失败的一种独特且不常见的模式。关于前哨淋巴结活检（SLNB）的发病率，预测因素和在途疾病的自然史存在的信息很少：1991年至2001年，1395例原发性黑色素瘤患者进行SLNB。单因素和多因素Logistic回归分析，以研究已知的临床病理因素，在途复发，和远处转移失败后，在途diseases.Results的发展之间的关联：中位随访时间为3.9年，241例（17.3%）经历了疾病复发，其中91（6.6%）谁开发的在途复发。在途复发的独立预测因素包括年龄> 50岁。原发肿瘤的下肢位置。Breslow深度、溃疡和前哨淋巴结（SLN）状态。在69例首次复发的唯一部位为在途疾病的患者中，39例发展为远处疾病。通过单变量分析，在途疾病患者中远端失败的预测因素包括SLN状态、SLN中最大转移灶> 2.5 mm（2）、在途疾病的皮下位置、在途肿瘤大小≥ 2 cm以及在途复发前无病间隔< 12个月。通过多变量分析，在途肿瘤大小仍然是远处转移的重要预测因素（优势比，9.69）。结论：接受SLNB的患者中在途转移的总体发生率较低，并且自引入SLNB技术以来似乎并未增加。在途复发，以及随后的远处转移失败，可以预测的基础上，不利的肿瘤因素和SLN的状态。
Background: In-transit recurrence is a unique and uncommon pattern of treatment failure in patients with melanoma. Little information exists concerning the incidence, predictors, and natural history of in-transit disease since the introduction of sentinel lymph node biopsy (SLNB).Methods: Between 1991 and 2001, 1395 patients with primary melanoma Underwent SLNB. Univariate and multivariate logistic regression analyses were performed to examine the association among known clinicopathologic factors, in-transit recurrence, and distant metastatic failure after the development of in-transit disease.Results: With a median follow-up of 3.9 years, 241 patients (17.3%) experienced disease recurrence, including 91 (6.6%) who developed in-transit recurrence. Independent predictors of in-transit recurrence included age > 50 years. a lower extremity location of the primary tumor. Breslow depth, ulceration, and sentinel lymph node (SLN) status. Of the 69 patients who presented with in-transit disease as the sole site of first recurrence, 39 developed distant disease. By univariate analysis, predictors of distant failure among patients with in-transit disease included SLN status, largest metastatic focus in the SLN > 2.5 mm(2), subcutaneous location of in-transit disease, in-transit tumor size >= 2 cm, and a disease-free interval before in-transit recurrence of < 12 months. In-transit tumor size remained a significant predictor of distant metastasis by multivariate analysis (odds ratio, 9.69).Conclusions: The overall incidence of in-transit metastases in patients undergoing SLNB is low and does not seem to have increased since the introduction of the SLNB technique. In-transit recurrence, as well as subsequent distant metastatic failure, can be predicted on the basis of adverse tumor factors and SLN status.