前哨淋巴结活检对黑色素瘤预后的预测价值

Predictive value of sentinel lymph node biopsy in prognosis of acral melanoma

目的探讨前哨淋巴结活检(SLNB)对黑色素瘤预后的预测价值。方法回顾性分析2012年3月至2019年6月北京积水潭医院诊治的118例黑色素瘤患者的临床病理资料。患者术前行体格检查和影像学检查排除区域淋巴结转移,采用99Tcm-右旋糖酐行术前示踪显像,术中γ射线探测仪精准定位,切取前哨淋巴结(SLN)行病理活检;原发灶局部行扩大切除重建术;SLN病理阳性患者行区域淋巴结清扫。采用Cox回归模型分析患者的预后及其影响因素。结果118例患者的病史为2~360个月,平均病史为53.6个月。原发灶位于手足84例,甲下27例,皮肤7例。平均Breslow厚度为3.6 mm,合并溃疡72例(61.0%,72/118)。全组患者平均切取SLN 2.8枚,SLN阳性29例(24.6%,29/118),假阴性率为2.5%(3/118)。淋巴结显性转移和远处转移24例(20.3%,24/118),其中远处转移合并淋巴结转移7例(5.9%,7/118),单纯淋巴结显性转移8例(6.8%,8/118),远处脏器转移9例(7.6%,9/118)。全组患者病理分期为Ⅰ期33例,Ⅱ期56例,Ⅲ期29例,5年生存率为69.5%。Breslow厚度为SLN阳性的独立危险因素,Breslow厚度、SLN状态、SLN阳性数目和远处转移是影响患者总生存的独立影响因素(均P<0.05)。结论对于临床及影像学检查无区域淋巴结转移的患者,SLNB能够提供准确的病理分期并预测患者的预后,临床应常规开展。

Objective To explore the application of sentinel lymph node biopsy(SLNB)and its prognostic value in the treatment of acral melanoma.Methods We retrospective analyzed 118 patients who underwent sentinel lymph node biopsy from Mar 2012 to Jun 2019 with effective follow-up data available in our institute.We ruled out palpable regional lymph node metastasis with preoperative imaging of MRI and ultrasonography,used the 99Tcm-Dextran(Dx)as a tracer,with intraoperativeγ-ray probe positioning for SLN capture.Wide resection and reconstruction in primary lesion followed by complete lymph node dissection were underwent SLN positive patients.Cox regression model were used to analyze the prognostic factors.Results The patients had an average disease history of 53.6 months(2-360 months),the primary lesion located at hands and feet in 84 cases,while 27 cases were subungual and 7 cases were cutaneous.The mean Breslow depth was 3.6 mm,and 72 cases(61.0%)combined with ulceration.The average number of SLN was 2.8,the SLN positive rate was 24.6%(29/118),and the false-negative rate was 2.5%(3/118).There were 24 cases(20.3%)developed clinically positive metastasis,including 7 cases displayed distant metastasis combined with lymph node metastasis(5.9%),8 cases with clinically positive lymph node metastasis alone(6.8%),and 9 cases with distant metastasis(7.6%).There were 33 patients in stageⅠ,56 patients in stageⅡand 29 patients in stageⅢ,with a 5-years overall survival rate of 69.5%.The Breslow depth is an independent risk factor of SLN positive.While Breslow depth,SLN status,SLN positive number and clinically detectable metastasis are independent prognostic factors of the overall survival(P<0.05).Conclusions Patients without clinically positive regional lymph node metastasis under imaging and physical examinations,SLNB can provide accurate pathologic staging and play an accurate prediction role in the prognostic evaluation.SLNB should be carried out routinely in clinical practice.