Diversity of Stage III Melanoma in the Era of Sentinel Lymph Node Biopsy

作者：Egger Michael E^*; Callender Glenda G; McMasters Kelly M; Ross Merrick I; Martin Robert C G II; Edwards Michael J; Urist Marshall M; Noyes R Dirk; Sussman Jeffrey J; Reintgen Douglas S; Stromberg Arnold J; Scoggins Charles R

来源：Annals of Surgical Oncology, 2013, 20(3): 956-963.

DOI：10.1245/s10434-012-2701-z

Sentinel lymph node (SLN) biopsy for melanoma often detects minimal nodal tumor burden. Although all node-positive patients are considered stage III, there is controversy regarding the necessity of adjuvant therapy for all patients with tumor-positive SLN. %26lt;br%26gt;Post hoc analysis was performed of a prospective multi-institutional study of patients with melanoma a parts per thousand yen 1.0 mm Breslow thickness. All patients underwent SLN biopsy; completion lymphadenectomy was performed for patients with SLN metastasis. Kaplan-Meier analysis of disease-free survival (DFS) and overall survival (OS) was performed. Univariate and multivariate Cox regression analyses were performed. Classification and regression tree (CART) analysis also was performed. %26lt;br%26gt;A total of 509 patients with tumor-positive SLN were evaluated. Independent risk factors for worse OS included thickness, age, gender, presence of ulceration, and tumor-positive non-SLN (nodal metastasis found on completion lymphadenectomy). As the number of tumor-positive SLN and the total number of tumor-positive nodes (SLN and non-SLN) increased, DFS and OS worsened on Kaplan-Meier analysis. On CART analysis, the 5-year OS rates ranged from 84.9 % (women with thickness %26lt; 2.1 mm, age %26lt; 59 years, no ulceration, and tumor-negative non-SLN) to 14.3 % (men with thickness a parts per thousand yen 2.1 mm, age a parts per thousand yen 59 years, ulceration present, and tumor-positive non-SLN). Six distinct subgroups were identified with 5-year OS in excess of 70 %. %26lt;br%26gt;Stage III melanoma in the era of SLN is associated with a very wide range of prognosis. CART analysis of prognostic factors allows discrimination of low-risk subgroups for which adjuvant therapy may not be warranted.

• 出版日期2013-3