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Sentinel Lymph Node Biopsy in Head and Neck Melanoma: Long-term Outcomes, Prognostic Value, Accuracy, and Safety.

头颈部黑色素瘤前哨淋巴结活检: 长期结局、预后价值、准确性和安全性。

  • 影响因子:2.23
  • DOI:10.1177/0194599819899934
  • 作者列表:"Hanks JE","Kovatch KJ","Ali SA","Roberts E","Durham AB","Smith JD","Bradford CR","Malloy KM","Boonstra PS","Lao CD","McLean SA
  • 发表时间:2020-04-01
Abstract

OBJECTIVE:To evaluate the long-term outcomes of sentinel lymph node biopsy (SLNB) for head and neck cutaneous melanoma (HNCM). STUDY DESIGN:Retrospective cohort study. SETTING:Tertiary academic medical center. SUBJECTS AND METHODS:Longitudinal review of a 356-patient cohort with HNCM undergoing SLNB from 1997 to 2007. RESULTS:Descriptive characteristics included the following: age, 53.5 ± 19 years (mean ± SD); sex, 26.8% female; median follow-up, 4.9 years; and Breslow depth, 2.52 ± 1.87 mm. Overall, 75 (21.1%) patients had a positive SLNB. Among patients undergoing completion lymph node dissection following positive SLNB, 20 (27.4%) had at least 1 additional positive nonsentinel lymph node. Eighteen patients with local control and negative SLNB developed regional disease, indicating a false omission rate of 6.4%, including 10 recurrences in previously unsampled basins. Ten-year overall survival (OS) and melanoma-specific survival (MSS) were significantly greater in the negative sentinel lymph node (SLN) cohort (OS, 61% [95% CI, 0.549-0.677]; MSS, 81.9% [95% CI, 0.769-0.873]) than the positive SLN cohort (OS, 31% [95% CI, 0.162-0.677]; MSS, 60.3% [95% CI, 0.464-0.785]) and positive SLN/positive nonsentinel lymph node cohort (OS, 8.4% [95% CI, 0.015-0.474]; MSS, 9.6% [95% CI, 0.017-0.536]). OS was significantly associated with SLN positivity (hazard ratio [HR], 2.39; P < .01), immunosuppression (HR, 2.37; P < .01), angiolymphatic invasion (HR, 1.91; P < .01), and ulceration (HR, 1.86; P < .01). SLN positivity (HR, 3.13; P < .01), angiolymphatic invasion (HR, 3.19; P < .01), and number of mitoses (P = .0002) were significantly associated with MSS. Immunosuppression (HR, 3.01; P < .01) and SLN status (HR, 2.84; P < .01) were associated with recurrence-free survival, and immunosuppression was the only factor significantly associated with regional recurrence (HR, 6.59; P < .01). CONCLUSIONS:Long-term follow up indicates that SLNB showcases durable accuracy, safety, and prognostic importance for cutaneous HNCM.

摘要

目的: 评价前哨淋巴结活检 (SLNB) 治疗头颈部皮肤黑色素瘤 (HNCM) 的长期疗效。 研究设计: 回顾性队列研究。 单位: 三级学术医学中心。 对象和方法: 对 1997 年至 2007 年接受SLNB的 356 例HNCM患者队列进行纵向回顾。 结果: 描述性特征包括: 年龄,53.5 ± 19 岁 (平均 ± SD); 性别,26.8% 为女性; 中位随访时间,4.9 年; Breslow深度,2.52 ± 1.87毫米。总体而言,75 例 (21.1%) 患者SLNB阳性。在SLNB阳性后接受完整淋巴结清扫的患者中,20 例 (27.4%) 至少有 1 例额外的非前哨淋巴结阳性。18 例局部对照、SLNB阴性的患者发生区域疾病,假漏检率为 6.4%,其中既往未取样盆地复发 10 例。阴性前哨淋巴结 (SLN) 队列的十年总生存率 (OS) 和黑色素瘤特异性生存率 (MSS) 显著更高 (OS,61% [95% CI,0.549-0.677]; MSS,81.9% [95% CI,0.769-0.873] 比阳性SLN队列 (OS,31% [95% CI,0.162-0.677];MSS,60.3% [95% CI,0.464-0.785]) 和阳性SLN/阳性非前哨淋巴结队列 (OS,8.4% [95% CI,0.015-0.474]; MSS,9.6% [95% CI,0.017-0.536])。OS与SLN阳性 (风险比 [HR],2.39; P < .01) 、免疫抑制 (HR,2.37; P < .01) 、血管淋巴侵犯 (HR,1.91; P < .01) 和溃疡 (HR,1.86; P <.01)。SLN阳性 (HR,3.13; P < .01) 、血管淋巴侵犯 (HR,3.19; P < .01) 和核分裂数目 (P = .0002) 与MSS显著相关。免疫抑制 (HR,3.01; P < .01) 和SLN状态 (HR,2.84; P < .01) 与无复发生存期相关,免疫抑制是唯一与区域复发显著相关的因素 (HR,6.59; P <.01)。 结论: 长期随访表明SLNB显示了皮肤HNCM的持久准确性、安全性和预后重要性。

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皮肤肿瘤方向

皮肤肿瘤是发生在皮肤的细胞增生性疾病,是一种常见病。发生于皮内或皮下组织的新生物,种类很多,临床上分良性肿瘤和恶性肿瘤。恶性肿瘤可以不断增殖,引起转移,威胁生命,称为皮肤癌。

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