Sentinel Lymph Node Biopsy for Melanoma: Indications and Rationale
Sentinel Lymph Node Biopsy for Melanoma: Indications and Rationale
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DOI：
10.1177/107327480901600305
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发表时间：
2009-07-01
期刊：
影响因子：
2.6
通讯作者：
Zager, Jonathan S.
中科院分区：
文献类型：
--
作者：
Phan, Giao Q.;Messina, Jane L.;Zager, Jonathan S.
背景：区域淋巴结的病变状态是黑色素瘤患者最重要的预后指标。前哨淋巴结活检(SLNB)被发展为一种外科技术，用来评估区域淋巴结和保留淋巴结阴性的患者不必要的和潜在的病理性完全淋巴切除。方法：我们回顾了关于SLNB治疗皮肤黑色素瘤的文献，以深入了解目前SLNB广泛使用的理论基础。结果：多项研究表明，SLN的状态是一个重要的预后指标。与SLN阴性患者相比，SLN阳性患者的无病生存率和黑色素瘤特异性生存率显著降低。在多中心选择性淋巴清扫试验I(MSLT-I)中，中等厚度黑色素瘤的患者随机接受SLNB(如果SLN阳性，立即完成淋巴清扫)与观察组(只有在出现临床明显复发后才进行淋巴清扫)，前哨淋巴结阳性患者的5年存活率为72.3%，前哨淋巴结阴性患者的5年存活率为90.2%(P<；.001)。虽然与随机观察的患者相比，接受SLNB的患者的总存活率没有增加，但接受SLNB的患者的5年无病存活率比只接受观察的患者显著增加(活检组和观察组分别为78.3%和73.1%；P=.009)。对于有淋巴结转移的患者，与那些仅在出现临床明显疾病后才接受淋巴清扫的患者相比，接受SLNB并立即进行淋巴清扫的患者的总体5年生存率更高(72.3%比52.4%；P=0.004)。此外，其他研究表明，对于厚度为0.76 mm的黑色素瘤患者，有丝分裂率的增加与SLN转移的发生率增加有关。结论：SLNB提供了重要的预后和分期数据，发病率最低，可用于识别区域淋巴结阴性患者，他们不会从完整的结节清扫中受益。在我们看来，SLNB应该在大多数有Breslow深度=0.76 mm的黑色素瘤患者(具有可接受的手术和麻醉风险)上进行。
Background: The disease status of regional lymph nodes is the most important prognostic indicator for patients with melanoma. Sentinel lymph node biopsy (SLNB) was developed as a technique to surgically assess the regional lymph nodes and spare node-negative patients unnecessary and potentially morbid complete lymphadenectomies.Methods: We reviewed the literature on SLNB for cutaneous melanoma to provide insight into the rationale for the current widespread use of SLNB.Results: Multiple studies show that the status of the SLN is an important prognostic indicator. Those with positive SLNs have significantly decreased disease-free and melanoma-specific survival compared with those who have negative SLNs. In the Multicenter Selective Lymphadenectomy Trial I (MSLT-I), in which patients with intermediate-thickness melanoma were randomized to SLNB (and immediate completion lymphadenectomy if the SLN was positive) vs observation (and a lymphadenectomy only after presenting with clinically evident recurrence), the 5-year survival rate was 72.3% for patients with positive sentinel nodes and 90.2% for those with negative sentinel nodes (P < .001). Although overall survival was not increased in patients who underwent SLNB compared with those who were randomized to observation, patients who underwent SLNB had a significantly increased 5-year disease-free survival rate compared with those who underwent observation alone (78.3% in the biopsy group and 73.1% in the observation group; P = .009). For those with nodal metastases, patients who underwent SLNB and immediate lymphadenectomy had an increased overall 5-year survival rate compared with those who had lymphadenectomy only after presenting with clinically evident disease (72.3% vs 52.4%; P = .004). Moreover, other studies show that for patients with thin melanomas = 0.76 mm and increased mitotic rate have been shown to be associated with an increased incidence of SLN metastases.Conclusions: SLNB provides important prognostic and staging data with minimal morbidity and can be used to identify regional node-negative patients who would not benefit from a complete nodal dissection. In our opinion, SLNB should be performed on most patients (with acceptable surgical and anesthesia risk) who have melanomas with a Breslow depth >= 0.76 mm.