Age as a Predictor of Sentinel Node Metastasis among Patients with Localized Melanoma: An Inverse Correlation of Melanoma Mortality and Incidence of Sentinel Node Metastasis Among Young and Old Patients
Age as a Predictor of Sentinel Node Metastasis among Patients with Localized Melanoma: An Inverse Correlation of Melanoma Mortality and Incidence of Sentinel Node Metastasis Among Young and Old Patients
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DOI：
10.1245/s10434-013-3464-x
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发表时间：
2014-04-01
影响因子：
3.7
通讯作者：
Sondak, Vernon K.
中科院分区：
文献类型：
--
作者：
Balch, Charles M.;Thompson, John F.;Sondak, Vernon K.
目的.我们以前曾报道，老年患者的临床阶段I和II原发性皮肤。与年轻患者相比，黑色素瘤患者的生存率较低。我们推测，淋巴结转移的发病率，因此将是较高的老年黑色素瘤患者。扩展的美国癌症联合委员会黑色素瘤分期数据库包含7，756例黑色素瘤患者的队列，这些患者没有区域淋巴结或远处转移的临床证据，并接受了前哨淋巴结活检手术作为其分期评估的一部分。尽管老年患者的原发性黑色素瘤特征与更具侵袭性的生物学特征相关，但我们矛盾地观察到前哨淋巴结转移的发生率随着患者年龄的增加而显著降低。总体而言，20岁以下患者的前哨淋巴结转移发生率最高，为25.8%，而80岁及以上患者为15.5%（p < 0.001）。相比之下，临床II期患者的5年死亡率范围从20-40岁患者的20%低至70岁以上患者的38%。在多因素分析中，患者年龄是前哨淋巴结转移的独立预测因素（p < 0.001）。20岁以下的临床I期和II期黑色素瘤患者的前哨淋巴结转移发生率较高，但与所有其他年龄组相比，生存结局更有利。相反，> 70岁的患者具有最具侵袭性的原发性黑色素瘤特征，与所有其他年龄组相比，其死亡率较高，但前哨淋巴结转移的发生率较低。
Purpose. We have previously reported that older patients with clinical stage I and II primary cutaneous. Melanoma had lower survival rates compared to younger patients. We postulated that the incidence of nodal metastasis would therefore be higher among older melanoma patients.Methods. The expanded American Joint Committee on Cancer melanoma staging database contains a cohort of 7,756 melanoma patients who presented without clinical evidence of regional lymph node or distant metastasis and who underwent a sentinel node biopsy procedure as a component of their staging assessment.Results. Although older patients had primary melanoma features associated with more aggressive biology, we paradoxically observed a significant decrease in the incidence of sentinel node metastasis as patient age increased. Overall, the highest incidence of sentinel node metastasis was 25.8 % in patients under 20 years of age, compared to 15.5 % in patients 80 years and older (p < 0.001). In contrast, 5-year mortality rates for clinical stage II patients ranged from a low of 20 % for those 20-40 years of age up to 38 % for those over 70 years of age. Patient age was an independent predictor of sentinel node metastasis in a multifactorial analysis (p < 0.001).Conclusions. Patients with clinical stage I and II melanoma under 20 years of age had a higher incidence of sentinel lymph node metastasis but, paradoxically, a more favorable survival outcome compared to all other age groups. In contrast, patients > 70 years had the most aggressive primary melanoma features and a higher mortality rate compared to all other age groups but a lower incidence of sentinel lymph node metastasis.