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Assessment of complete lymph node dissection in patients with melanoma:A systemic review and meta-analysis
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作者 Jiangying Xuan Ming Zhu +6 位作者 Lu Wang Zixu Gao Kangjie Shen Ming Ren Yanlin Li Chuanyuan Wei Jianying Gu 《Chinese Journal of Plastic and Reconstructive Surgery》 2023年第4期195-204,共10页
Background: Complete lymph node dissection(CLND) for patients with melanoma remains controversial. This meta-analysis aimed to compare the prognoses and complications between the CLND and control groups(patients who r... Background: Complete lymph node dissection(CLND) for patients with melanoma remains controversial. This meta-analysis aimed to compare the prognoses and complications between the CLND and control groups(patients who receive adjuvant treatment or observation only) in patients with sentinel lymph node(SLN)-positive melanoma.Methods: The Pub Med, Embase, Cochrane, and Web of Science databases were searched for cohort studies and randomized clinical trials(RCTs) conducted between 1964 and 2022, and the quality of the studies was assessed using the Cochrane risk-of-bias tool and Newcastle-Ottawa Scale. Hazard ratios(HR) or risk ratios(RR) with 95%confidence intervals(CIs) were calculated for each outcome. Heterogeneity and sensitivity tests were also conducted, and publication bias tests were performed when the pooled number of studies was >10.Results: Fifteen studies, including 11 cohort studies and 4 RCTs, were enrolled and assessed for quality. Analysis of overall survival showed no significant difference between the CLND and control groups(HR=1.02, 95% CI:0.69–1.51, P=0.922). Similarly, recurrence-free survival(HR=0.84, 95% CI: 0.6–1.16, P=0.287), disease-free survival(HR=1.06, 95% CI: 0.65–1.72, P=0.82), and disease-specific survival(HR=0.84, 95% CI: 0.59–1.21,P=0.355) showed no difference between the two groups. CLND did not reduce the risk of recurrence(RR=0.98,95% CI: 0.8–1.2, P=0.851).Conclusion: Remarkably, patients who underwent CLND were more likely to have complications such as flap necrosis and lymphedema than the controls. CLND does not improve patient prognosis and may increase the incidence of complications. 展开更多
关键词 MELANOMA complete lymph node dissection META-ANALYSIS
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Diagnostic biopsy of cutaneous melanoma, sentinel lymph node biopsy and indications for lymphadenectomy
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作者 Efstathios T Pavlidis Theodoros E Pavlidis 《World Journal of Clinical Oncology》 CAS 2022年第10期861-865,共5页
The incidence of cutaneous melanoma appears to be increasing worldwide and this is attributed to solar radiation exposure.Early diagnosis is a challenging task.Any clinically suspected lesion must be assessed by compl... The incidence of cutaneous melanoma appears to be increasing worldwide and this is attributed to solar radiation exposure.Early diagnosis is a challenging task.Any clinically suspected lesion must be assessed by complete diagnostic excision biopsy(margins 1-2 mm);however,there are other biopsy techniques that are less commonly used.Melanomas are characterized by Breslow thickness as thin(<1 mm),intermediate(1-4 mm)and thick(>4 mm).This thickness determines their biological behavior,therapy,prognosis and survival.If the biopsy is positive,a wide local excision(margins 1-2 cm)is finally performed.However,metastasis to regional lymph nodes is the most accurate prognostic determinant.Therefore,sentinel lymph node biopsy(SLNB)for diagnosed melanoma plays a pivotal role in the management strategy.Complete lymph node clearance has undoubted advantages and is recommended in all cases of positive SLN biopsy.A PET-CT(positron emission tomography-computed tomography)scan is necessary for staging and follow-up after treatment.Novel targeted therapies and immunotherapies have shown improved outcomes in advanced cases. 展开更多
关键词 Surgical oncology Malignant melanoma Skin cancer Cutaneous melanoma Sentinel lymph node biopsy complete lymph node dissection
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Macrometastasis at selective lymph node biopsy:A practical goingfor-the-one clinical scoring system to personalize decision making
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作者 Mercedes Herrero Raquel Ciérvide +5 位作者 Maria Elisa Calle-Purón Javier Valero Paula Buelga Isabel Rodriguez-Bertos Leticia Benassi Angel Montero 《World Journal of Clinical Oncology》 CAS 2021年第8期675-687,共13页
BACKGROUND Axillary sentinel lymph node biopsy(SLNB)is standard treatment for patients with clinically and pathological negative lymph nodes.However,the role of completion axillary lymph node dissection(cALND)followin... BACKGROUND Axillary sentinel lymph node biopsy(SLNB)is standard treatment for patients with clinically and pathological negative lymph nodes.However,the role of completion axillary lymph node dissection(cALND)following positive sentinel lymph node biopsy(SLNB)is debated.AIM To identify a subgroup of women with high axillary tumor burden undergoing SLNB in whom cALND can be safely omitted in order to reduce the risk of longterm complications and create a Preoperative Clinical Risk Index(PCRI)that helps us in our clinical practice to optimize the selection of these patients.METHODS Patients with positive SLNB who underwent a cALND were included in this study.Univariate and multivariate analysis of prognostic and predictive factors were used to create a PCRI for safely omitting cALND.RESULTS From May 2007 to April 2014,we performed 1140 SLN biopsies,of which 125 were positive for tumor and justified to practice a posterior cALND.Pathologic findings at SLNB were micrometastases(mic)in 29 cases(23.4%)and macrometastasis(MAC)in 95 cases(76.6%).On univariate analysis of the 95 patients with MAC,statistically significant factors included:age,grade,phenotype,histology,lymphovascular invasion,lymph-node tumor size,and number of positive SLN.On multivariate analysis,only lymph-node tumor size(≤20 mm)and number of positive SLN(>1)retained significance.A numerical tool was created giving each of the parameters a value to predict preoperatively which patients would not benefit from cALND.Patients with a PCRI≤15 has low probability(<10%)of having additional lymph node involvement,a PRCI between 15-17.6 has a probability of 43%,and the probability increases to 69%in patients with a PCRI>17.6.CONCLUSION The PCRI seems to be a useful tool to prospectively estimate the risk of nodal involvement after positive SLN and to identify those patients who could omit cALND.Further prospective studies are necessary to validate PCRI clinical generalization. 展开更多
关键词 Sentinel lymph node biopsy complete axillary lymph node dissection Preoperative clinical risk index Macrometastasis
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Can axillary radiotherapy replace axillary dissection for patients with positive sentinel nodes? A systematic review and meta-analysis 被引量:3
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作者 Min Zhao Wei-Guang Liu +8 位作者 Lei Zhang Zi-Ning Jin Zhan Li Cheng Liu Dong-Bao Li Ying Ma Jing-Wen Zhang Feng Jin Bo Chen 《Chronic Diseases and Translational Medicine》 CSCD 2017年第1期-,共10页
Objective: To compare the efficacy of axillary radiotherapy (ART) with that of completion axillary lymph node dissection (cALND) in clinically node-negative breast cancer patients with a positive sentinel lymph node. ... Objective: To compare the efficacy of axillary radiotherapy (ART) with that of completion axillary lymph node dissection (cALND) in clinically node-negative breast cancer patients with a positive sentinel lymph node. Methods: A literature search was performed in PubMed, EMBASE and Cochrane Library by using the search terms 'breast cancer', 'sentinel lymph node biopsy', 'axillary radiotherapy' or 'regional node irradiation' for articles published between 2004 and 2016. Only randomized controlled trials that included patients with positive sentinel nodes were included in the meta-analysis. Results: Two randomized controlled trials and three retrospective studies were identified. The reported overall survival rate (hazard ratio [HR] = 1.09, 95% confidence interval [CI]: 0.75-1.43, P = 0.365), disease-free survival rate (HR = 1.01, 95% CI:0.58-1.45, P = 0.144), and axillary recurrence rate (1.2% and 0.4%, and 1.3% and 0.8%, respectively) were similar in both groups. The absence of knowledge on the extent of nodal involvement in the ART group appeared to have no major impact on the administration of adjuvant systemic therapy. Conclusions: ART is not inferior to cALND in the patients with clinically node-negative breast cancer who had a positive sentinel lymph node. Information obtained by using cALND after SLNB may have no major impact on the administration of adjuvant systemic therapy. 展开更多
关键词 Breast cancer Sentinel lymph node biopsy Completion axillary lymph node dissection Axillary radiotherapy META-ANALYSIS
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The prognostic significance of non-sentinel lymph node metastasis in cutaneous and acral melanoma patients—A multicenter retrospective study 被引量:2
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作者 Wei Sun Yu Xu +6 位作者 JiLong Yang ZhiChao Liao Tao Li Kai Huang Poulam Patel WangJun Yan Yong Chen 《Cancer Communications》 SCIE 2020年第11期586-597,共12页
Background:Whether non-sentinel lymph node(SLN)-positive melanoma patients can benefit from completion lymph node dissection(CLND)is still unclear.The current study was performed to identify the prognostic role of non... Background:Whether non-sentinel lymph node(SLN)-positive melanoma patients can benefit from completion lymph node dissection(CLND)is still unclear.The current study was performed to identify the prognostic role of nonSLN status in SLN-positive melanoma and to investigate the predictive factors of non-SLN metastasis in acral and cutaneous melanoma patients.Methods:The records of 328 SLN-positive melanoma patients who underwent radical surgery at four cancer centers from September 2009 to August 2017 were reviewed.Clinicopathological data including age,gender,Clark level,Breslow index,ulceration,the number of positive SLNs,non-SLN status,and adjuvant therapy were included for survival analyses.Patients were followed up until death or June 30,2019.Multivariable logistic regression modeling was performed to identify factors associated with non-SLN positivity.Log-rank analysis and Cox regression analysis were used to identify the prognostic factors for disease-free survival(DFS)and overall survival(OS).Results:Among all enrolled patients,220(67.1%)had acral melanoma and 108(32.9%)had cutaneous melanoma.The 5-year DFS and OS rate of the entire cohort was 31.5%and 54.1%,respectively.More than 1 positive SLNs were found in 123(37.5%)patients.Positive non-SLNs were found in 99(30.2%)patients.Patients with positive non-SLNs had significantly worse DFS and OS(log-rank P<0.001).Non-SLN status(P=0.003),number of positive SLNs(P=0.016),and adjuvant therapy(P=0.025)were independent prognostic factors for DFS,while non-SLN status(P=0.002),the Breslow index(P=0.027),Clark level(P=0.006),ulceration(P=0.004),number of positive SLNs(P=0.001),and adjuvant therapy(P=0.007)were independent prognostic factors for OS.The Breslow index(P=0.020),Clark level(P=0.012),and number of positive SLNs(P=0.031)were independently related to positive non-SLNs and could be used to develop more personalized surgical strategy.Conclusions:Non-SLN-positive melanoma patients had worse DFS and OS even after immediate CLND than those with non-SLN-negative melanoma.The Breslow index,Clark level,and number of positive SLNs were independent predictive factors for non-SLN status. 展开更多
关键词 completion of lymph node dissection disease-free survival MELANOMA non-sentinel lymph node overall survival prognostic factors
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