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1.
Cristina Fortes Simona Mastroeni Alessio Caggiati Francesca Passarelli Alba Zappalà Maria Capuano Riccardo Bono Maurizio Nudo Claudia Marino Paola Michelozzi 《American journal of surgery》2016,212(5):935-940
Background
Whether timing of sentinel lymph node biopsy (SLNB) in cutaneous melanoma improves survival is not yet clear. The aim of this study was to investigate if the timing of SLNB influences long-term melanoma mortality.Methods
A 10-year retrospective cohort study was conducted on 748 cutaneous melanoma patients who underwent excision of the SLN. Hazard ratios and 95% confidence intervals were estimated from Cox proportional hazards models.Results
After adjusting for sex, age, Breslow thickness, mitotic rate, ulceration, and histologic type, patients who underwent early SLNB (≤30 days) and resulted positive on final pathology had a 3 times decreased risk of melanoma mortality (hazard ratio = .29; 95%confidence interval = .11 to .77) in comparison to patients who underwent delayed SLNB (≥31 days) and resulted positive on final pathology.Conclusions
Our findings suggest that early SLNB (≤30 days) improves melanoma survival. 相似文献2.
Background
The role of sentinel lymph node status (SLNS) in thick melanoma is evolving. The purpose of this study was to determine the prognostic value of SLNS in thick melanoma.Methods
A retrospective analysis of 120 prospectively collected clinically node-negative thick melanomas over 5 years was performed. Patient (age/sex) and tumor (thickness, ulceration, SLNS, mitoses, metastases, and recurrence) features were collected. Multivariate analysis was performed using Cox proportional hazard model.Results
Factors predictive of positive SLN included male sex, ulceration, and high mitoses. Factors associated with positive SLN had higher local–regional recurrence and metastases than negative SLN. SLNS and tumor thickness impacted 5-year disease–free survival (DFS) and overall survival (OS). Positive SLN, ulceration, age, and mitoses were independent predictors of DFS/OS.Conclusions
Nonulcerated/lower mitoses thick melanomas had lower positive SLN rates. Positive SLN develop recurrence and metastases and have worse OS/DFS. SLNS is an important prognosticator for OS/DFS. Sentinel lymph node biopsy delineates prognostic groups in thick melanomas and can impact management. 相似文献3.
Dhruvil R. Shah Anthony D. Yang Emanual Maverakis Steve R. Martinez 《The Journal of surgical research》2013
Background
Guidelines recommend that patients with melanoma metastatic to the sentinel lymph node (SLN) undergo a completion lymphadenectomy (CLND) of the affected lymph node basin. We have previously reported on decreased use of SLN biopsy among elderly patients. We hypothesized that elderly patients with SLN metastases would have lower rates of CLND relative to their younger counterparts.Methods
The Surveillance, Epidemiology, and End Results database was queried for patients who underwent SLN biopsy for intermediate thickness cutaneous melanoma (Breslow thickness 1.01 mm–4.00 mm) from 2004 to 2008 and were found to have SLN metastasis. Patients were categorized according to age by decade. We then used multivariate logistic regression models to predict receipt of CLND. Additional covariates included sex, race/ethnicity, T stage, tumor histology, tumor location, and ulceration. The likelihood of receiving a CLND was reported as OR with 95% CI; significance was set at P ≤ 0.05.Results
Entry criteria were met by 765 patients. Of these, 548 (71.6%) patients underwent CLND. On multivariate analysis, patients in the age groups 70–79 y old (OR 0.39, CI 0.20–0.78; P = 0.007) and ≥80 y old (OR 0.27, CI 0.12–0.61; P = 0.001) were less likely to undergo CLND than the youngest age group (1–39 y old).Conclusions
Elderly patients with SLN metastasis are less likely to receive CLND than their younger counterparts. A multi-center randomized clinical trial evaluating the potential survival benefit of CLND is ongoing. Further research to assess reasons why the elderly are less likely to receive CLND are needed. 相似文献4.
Michelle C. Ellis 《American journal of surgery》2010,199(5):663-668
Background
The authors updated their experience with sentinel lymph node (SLN) biopsy of clinically node negative (N0) melanoma to clarify indications, predictive factors, and outcomes.Methods
A review of patients from the authors' institution's prospective database (n = 397) was performed; survival statistics were obtained from the institutional tumor registry.Results
The SLN-positive (SLN+) rate was 16% (47 of 282) for lesions >1 mm thick; only 2 of 105 T1 lesions were SLN+. Thickness >2 mm, upper extremity primary, and ulceration predicted SLN+ status. Most SLN+ patients underwent completion node dissection; 12% had additional positive nodes. The false-negative SLN biopsy rate was 4.0%; the majority involved lower extremity and head and neck primaries. The overall complication rate was 26%; all were minor and resolved within 6 months. Overall 5-year survival rates were 73% and 92% for SLN+ and SLN-negative patients, respectively. SLN status was the most significant predictor of survival.Conclusions
SLN status, the most important determinant of outcome for clinically N0 melanoma, correlated with T stage, ulceration, and site. Staging of T1 lesions had low yield. A minority of completion node dissections yielded additional positive nodes. 相似文献5.
Yonick DV Ballo RM Kahn E Dahiya M Yao K Godellas C Shoup M Aranha GV 《American journal of surgery》2011,(3):324-328
Background
The treatment of thin melanoma (Breslow thickness <1.0 mm) may include sentinel lymph node (SLN) biopsy (SLNB). The validity of SLNB for thin melanoma remains widely debated. The purpose of this study was to elucidate pathologic factors that are predictive of SLN positivity.Methods
A retrospective analysis of a prospective database revealed 1,199 patients diagnosed with primary cutaneous melanoma. Multiple logistic regression was used to determine an association between pathologic factors and SLN positivity.Results
Thin melanomas were identified in 469 patients (39%). Of these, 147 patients (31%) underwent SLNB. Positive SLNs were found in 16 patients (11%). Multiple logistic regression demonstrated that both ulceration (odds ratio, 5.27; P = .047) and thickness (odds ratio, 46.69; P = .022) were associated with SLN positivity.Conclusions
Patients with thin melanomas >.75 mm and/or ulceration should be considered for SLNB. 相似文献6.
Background/Purpose
The management of pediatric melanoma is controversial but equates that of adults. Lymphatic mapping with sentinel lymph node (SLN) biopsy is proposed as standard of care for patients with primary melanoma. The operation can be done with general or local anesthesia in adults. The goal of this study was to determine the applicability of subcutaneous infusion anesthesia (SIA) for SLN biopsy in children and adolescents, as well as to assess complications of this procedure and to document outcome of patients with melanoma in this particular age group after SLN biopsy.Methods
Charts of patients with melanomas on the trunk and extremities who underwent lymphatic mapping and SLN biopsy in SIA between November 2000 and January 2006 revealed 13 patients with age 21 years or less. Tumescent solutions with lidocaine (0.2%) were used for SLN biopsy. Patient demographics, tumor thickness, Clark level, location of primary melanoma, ulceration, number of SLNs, number of positive nodes, and follow-up of patients were included.Results
In 13 patients (age range, 12-21), SLN biopsy was performed. Mean tumor thickness was 1.8 mm (range, 1.0-7.0), none of these melanomas showed ulceration. The operation was tolerated in SIA by all patients; none had any associated complications. Of 13 patients, 5 (38.5%) had positive sentinel nodes. Three patients underwent completion lymph node dissection, and no further positive nodes were found. After a mean follow-up of 29.2 months (range, 13-68), all patients were found disease-free.Conclusions
Sentinel lymph node biopsy in SIA can safely be performed in children and adolescents with primary melanomas. Further studies are necessary to determine the prognostic information and therapeutic implications of SLN biopsy in this patient group. 相似文献7.
Roberto Patuzzo Andrea Maurichi Tiziana Camerini Gianfranco Gallino Roberta Ruggeri Giulia Baffa Ilaria Mattavelli Maria Carla Tinti Federica Crippa Daniele Moglia Elena Tolomio Marco Maccauro Mario Santinami 《The Journal of surgical research》2014
Background
Debate remains around the accuracy and prognostic implications of sentinel lymph node biopsy (SLNB) for melanoma arising in the head and neck (HN) areas because several analyses have shown discordances between clinically predicted lymphatic drainage pathways and those identified by lymphoscintigraphy. This study assesses the accuracy and prognostic value of SLNB in this critical anatomic region.Methods
Retrospective review of a prospectively collected melanoma database identified 331 patients with HN melanomas from January 2000 to December 2012. Primary end points included SLNB result, time to recurrence, site of recurrence, and survival. Multivariate models were constructed for analyses.Results
A sentinel lymph node (SLN) was identified in all 331 patients. There were 59 patients with a positive SLN (17.8%) with a recurrence rate of 88.1% compared with 22.4% in SLN-negative patients (P < 0.0001). The 5-y overall survival was 91.2% for SLN-negative patients and 48.7% for SLN-positive patients (P < 0.0001). Patients with scalp melanoma had thicker lesions and an elevated risk of SLN positivity, recurrence, and death compared with those with other sites. Among the 272 SLN-negative patients, four patients developed regional nodal disease in the same basin and had undergone a previous SLNB procedure for a false-omission rate of 1.45%. Risks for false-negative SLN occurrences included thick and scalp melanomas. Multivariate analysis on prognostic factors affecting relapse-free survival showed positive SLNB status to be the most prognostic clinicopathologic predictor of recurrence (hazard ratio, 20.56; P < 0.0001).Conclusions
SLNB for patients with HN melanomas is an accurate procedure and has prognostic value. 相似文献8.
Lymphovascular Invasion Enhances the Prediction of Non-Sentinel Node Metastases in Breast Cancer Patients With Positive Sentinel Nodes 总被引:17,自引:7,他引:10
Weiser MR Montgomery LL Tan LK Susnik B Leung DY Borgen PI Cody HS 《Annals of surgical oncology》2001,8(2):145-149
Background:Fifty percent of patients with sentinel lymph node (SLN) metastases have no metastatic disease in non-SLNs on axillary lymph node dissection (ALND). The goal of this study is to determine which patients have metastatic disease limited to the SLN, and, therefore, may not require completion ALND.Methods:Of the first 1000 patients undergoing SLN biopsy at Memorial Sloan-Kettering Cancer Center, using a combined blue dye and isotope technique, 231 (26%) had positive SLN. Of these, 206 underwent completion ALND. They are the study group for this report.Results:The likelihood of non-SLN metastasis was inversely related to three clinicopathologic variables: tumor size 1.0 cm; absence of lymphovascular invasion (LVI); and SLN micrometastases ( 2 mm). None of 24 patients with all three predictive factors had non-SLN metastases, whereas 58% of patients with none of the factors had disease in the non-SLN.Conclusion:Patients with small breast cancers, no LVI, and SLN micrometastases have a low risk of non-SLN metastases, and may not require completion ALND.Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, New Orleans, Louisiana, March 16-19, 2000 相似文献
9.
Teresa S. Jones Edward L. Jones Dexiang Gao Nathan W. Pearlman William A. Robinson Martin McCarter 《American journal of surgery》2013
Background
The external ear represents a site with high ultraviolet exposure and thin skin overlying cartilage. The aim of this study was to determine if ear melanomas have different characteristics than cutaneous melanomas in other anatomic sites.Methods
The evaluation of patients treated at a tertiary care center.Results
Sixty patients were treated for ear melanoma (87% male, mean age = 56.7, mean thickness = 1.65 mm). Seven of thirty-two patients (22%) who underwent sentinel lymph node biopsy had positive nodes. Twenty (33%) patients had recurrence including 6 patients with negative sentinel lymph nodes (SLNs) and 5 patients with positive SLNs. Three of 10 patients (30%) treated with Mohs surgery had local recurrence.Conclusions
The overall local and systemic recurrences are similar to those previously reported. There is a higher recurrence rate than expected in patients with a negative SLN and a high local recurrence rate after Mohs surgery. Our data suggest that SLN evaluation may be less accurate in ear melanomas and that Mohs surgery may be associated with a relatively high local recurrence rate. 相似文献10.
Zheng WangXingmao Zhang MD Junjie HuWeigen Zeng MD Jianwei LiangHaitao Zhou MD Zhixiang Zhou 《The Journal of surgical research》2014
Background
The prognosis of early gastric cancer (EGC) with signet ring cell histology is more favorable than other undifferentiated gastric adenocarcinomas. An accurate assessment of potential lymph node metastasis is important for the appropriate treatment of EGC with signet ring cell histology. Therefore, this study analyzed the predictive factors associated with lymph node metastasis in patients with this type of EGC.Methods
A total of 136 EGC with signet ring cell histology patients who underwent D2 radical gastrectomy were reviewed in this study. The clinicopathologic features were analyzed to identify predictive factors for lymph node metastasis.Results
The overall rate of lymph node metastasis in EGC with signet ring cell histology was 10.3%. Using a univariate analysis, the risk factors for lymph node metastasis were identified as the tumor size, depth of tumor invasion, and lymphovascular invasion. The multivariate analysis revealed that tumor size >2 cm, submucosal invasion, and lymphovascular invasion were independent risk factors of lymph node metastasis (P < 0.05).Conclusions
The risk of lymph node metastasis of EGC with signet ring cell histology was high in those with tumor sizes ≥2 cm, submucosal tumors, and lymphovascular invasion. A minimally invasive treatment, such as endoscopic resection, might be possible in highly selective cases of EGC with signet ring cell histology with intramucosal invasion, tumor size <2 cm, and no lymphovascular invasion. 相似文献11.
White RL Ayers GD Stell VH Ding S Gershenwald JE Salo JC Pockaj BA Essner R Faries M Charney KJ Avisar E Hauschild A Egberts F Averbook BJ Garberoglio CA Vetto JT Ross MI Chu D Trisal V Hoekstra H Whitman E Wanebo HJ Debonis D Vezeridis M Chevinsky A Kashani-Sabet M Shyr Y Berry L Zhao Z Soong SJ Leong SP;Sentinel Lymph Node Working Group 《Annals of surgical oncology》2011,18(13):3593-3600
Background
Numerous predictive factors for cutaneous melanoma metastases to sentinel lymph nodes have been identified; however, few have been found to be reproducibly significant. This study investigated the significance of factors for predicting regional nodal disease in cutaneous melanoma using a large multicenter database.Methods
Seventeen institutions submitted retrospective and prospective data on 3463 patients undergoing sentinel lymph node (SLN) biopsy for primary melanoma. Multiple demographic and tumor factors were analyzed for correlation with a positive SLN. Univariate and multivariate statistical analyses were performed.Results
Of 3445 analyzable patients, 561 (16.3%) had a positive SLN biopsy. In multivariate analysis of 1526 patients with complete records for 10 variables, increasing Breslow thickness, lymphovascular invasion, ulceration, younger age, the absence of regression, and tumor location on the trunk were statistically significant predictors of a positive SLN.Conclusions
These results confirm the predictive significance of the well-established variables of Breslow thickness, ulceration, age, and location, as well as consistently reported but less well-established variables such as lymphovascular invasion. In addition, the presence of regression was associated with a lower likelihood of a positive SLN. Consideration of multiple tumor parameters should influence the decision for SLN biopsy and the estimation of nodal metastatic disease risk. 相似文献12.
JAC Fauri F Ricardi ES Diehl A Cartell R Furian L Bakos MI Edelweiss 《CANADIAN JOURNAL OF PLASTIC SURGERY》2011,19(3):77-81
BACKGROUND:
Cutaneous melanoma dermal invasion, identified through measurement of maximum tumour thickness and sentinel lymph node (SLN) biopsy, is important to establish melanoma prognosis and progression. P16 protein expression has been shown to be a predictive factor for melanoma evolution and prognosis.OBJECTIVE:
To investigate p16 protein expression in cutaneous melanomas with and without SLN metastasis.PATIENTS AND METHODS:
Sixty-seven paraffin-embedded cutaneous melanoma specimens of patients who had undergone SLN investigation were evaluated from 1995 to 2007. SLN biopsy was negative for metastasis in 34 of these patients (controls); in the remaining 33 patients, SLN biopsy was positive (cases). The expression of p16 protein in the primary tumour was measured using an immunohistochemical assay. The samples were classified according to their nuclear expression.RESULTS:
P16 nuclear expression was absent in 14 cases and in 15 controls; P=0.812. There was no statistically significant difference in p16 nuclear expression between cases and controls.CONCLUSIONS:
The present study does not support the findings of other studies that suggest p16 protein expression is important in the prognosis of cutaneous melanoma. 相似文献13.
Vuylsteke RJ Borgstein PJ van Leeuwen PA Gietema HA Molenkamp BG Statius Muller MG van Diest PJ van der Sijp JR Meijer S 《Annals of surgical oncology》2005,12(6):440-448
Background Even though 60% to 80% of melanoma patients with a positive sentinel lymph node (SLN) have no positive additional lymph nodes (ALNs), all these patients are subjected to an ALN dissection (ALND) with its associated morbidity. The aim of this study was to predict the absence of ALN metastases in patients with a positive SLN by using features of the primary melanoma and SLN tumor load.Methods Of 71 SLN-positive patients, 52 had metastasis limited to the SLN (group 1), and 19 had 1 positive ALN after ALND (group 2). The tumor load of the SLN was assessed by measuring the total surface area by computerized morphometry. Breslow thickness, ulceration and lymphatic invasion of the primary tumor, and total SLN metastatic area were tested as covariates predicting the absence of positive ALNs.Results The mean SLN metastatic area was 1.18 mm2 (group 1) and 3.39 mm2 (group 2) (P = .003) and was the only significant and independent factor after multivariate analysis (P = .02). None of the patients with both a Breslow thickness <2.5 mm and an SLN metastatic area <.3 mm2 had a positive ALN.Conclusions SLN metastatic area can be used to predict the absence of positive ALNs in melanoma patients. In this study, patients with a Breslow thickness <2.5 mm and an SLN tumor load <.3 mm2 seemed to have no positive ALN and had excellent survival. We hypothesize that this subgroup might not benefit from ALND. Prospective larger trials, using this model and randomizing between ALND and no ALND, should confirm this hypothesis.Published by Springer Science+Business Media, Inc. © 2005 The Society of Surgical Oncology, Inc. 相似文献
14.
Reoperative Sentinel Lymph Node Biopsy: A New Frontier in the Management of Ipsilateral Breast Tumor Recurrence 总被引:4,自引:1,他引:3
Port ER Garcia-Etienne CA Park J Fey J Borgen PI Cody HS 《Annals of surgical oncology》2007,14(8):2209-2214
Background
Breast conservation therapy (BCT) with sentinel lymph node (SLN) biopsy is a well-established standard of care for primary operable breast cancer; 5–10% of BCT patients will develop local recurrence (LR). The question then arises: How best to manage the axilla in the setting of LR after previous BCT and SLN biopsy or axillary dissection (ALND)?Methods
Between 9/96 and 12/04, 117 reoperative SLN were performed for LR after BCT and either SLN biopsy or ALND more than 6 months previously. Because of wide variation in the number of nodes removed at the initial procedure, validation by backup ALND was not feasible in all cases.Results
Reoperative SLN was successful in 64/117 (55%) patients. SLNs were identified by isotope and dye in 28/64 (44%); isotope only in 29/64 (45%); dye only in 4/64 (6%); 3/64 (5%) unknown. Positive reoperative SLN were found in 10/64 (16%) successful cases. Among 54/64 (84%) patients with negative reoperative SLNs, 23 (43%) had additional non-SLN removed concurrently: these were negative in 21/23 cases (91%). In 2/23 (9%), reoperative SLN were falsely negative: one with a positive intramammary node, and the other with a positive non-SLN palpated at surgery. Success of reoperative SLN was inversely related to number of nodes removed previously, and was more likely to be successful after a previous SLN biopsy than a previous ALND (74% vs. 38%, P = 0.0002). Non-axillary drainage was identified by lymphoscintigraphy significantly more often in reoperative SLN than in primary SLN biopsy (30% vs. 6%, P < 0.0001). There were no local or axillary recurrences at a mean follow up of 2.2 years; 6 patients developed systemic recurrence.Conclusions
Reoperative SLN biopsy is feasible in the setting of LR after previous BCT/axillary surgery and deserves further study in this increasingly common clinical scenario. The added benefit of lymphoscintigraphy in identifying sites of non-axillary drainage may be greater in the setting of reoperative SLN than for the initial SLN procedure.15.
Dhruvil R. Shah Anthony D. Yang Emanual Maverakis Steve R. Martinez 《The Journal of surgical research》2013
Background
We hypothesized that patients in urban areas with intermediate thickness cutaneous melanoma would have higher rates of sentinel lymph node biopsy (SLNB) relative to their rural-dwelling counterparts.Methods
The Surveillance, Epidemiology, and End Results database was queried for patients who underwent surgery for intermediate thickness cutaneous melanoma from 2004–2008. Patients were categorized as coming from urban or rural counties based on a nine-point scale. We used multivariate logistic regression models to predict use of SLNB. Covariates examined included sex, race/ethnicity, age, T stage, tumor histology, tumor location, and ulceration. The likelihood of undergoing SLNB was reported as OR with 95% CI.Results
Of 8441 patients, 8382 (99.3%) had complete information regarding use of SLNB. On multivariate analysis, patients from rural counties had a decreased likelihood of receiving a SLNB (OR 0.87, CI 0.78–0.97; P = 0.014). Additional factors associated with a decreased likelihood of receiving a SLNB included increasing age, Asian/Hispanic/Unknown race, and head and neck or overlapping primary tumor site.Conclusions
Patients in rural areas are less likely to receive a SLNB for intermediate thickness cutaneous melanoma than their urban-dwelling counterparts. 相似文献16.
Cho J Han W Lee JW Ko E Kang SY Jung SY Kim EK Moon WK Cho N Park IA Chung JK Hwang KT Kim SW Noh DY 《Annals of surgical oncology》2008,15(8):2278-2286
Background The majority of breast cancer patients with metastatic sentinel lymph node (SLN) do not harbor additional metastasis in non-SLN.
It is unclear which patients with metastatic SLN require axillary lymph node dissection (ALND). The aim of this study was
to identify predictive factors of non-SLN metastasis and to develop a scoring system.
Methods The training dataset consisted of 184 breast cancer patients. The independent validation dataset consisted of 82 breast cancer
patients. The receiver operating characteristic (ROC) curve was drawn and the area under the ROC curve (AUC) was calculated
to assess the discriminative power of the scoring systems.
Results Multivariate analysis revealed that non-SLN status was predicted by preoperative ultrasonographic findings of the axilla,
lymphovascular invasion, increasing tumor size, increasing number of metastatic SLN, and decreasing number of nonmetastatic
SLN. Based on multivariate logistic regression, we developed a scoring system for predicting non-SLN metastasis. The AUC for
our scoring system was superior to other published scoring systems when identical validation data were applied.
Conclusion The likelihood of metastatic non-SLN correlated with preoperative ultrasonographic findings of the axilla, increasing pathologic
size of the primary tumor, presence of lymphovascular invasion, increasing number of metastatic SLN, and decreasing number
of nonmetastatic SLN. Our scoring system appears to be effective and accurate for selecting patients for whom ALND can be
avoided. 相似文献
17.
Niels M. Graafland Wayne Lam Joost A.P. Leijte Tet Yap Maarten P.W. Gallee Cathy Corbishley Erik van Werkhoven Nick Watkin Simon Horenblas 《European urology》2010
Background
The European Association of Urology (EAU) guidelines advise an elective bilateral lymphadenectomy in clinically node-negative (cN0) patients with high-risk penile carcinoma (≥pT2, G3, or lymphovascular invasion [LVI]).Objective
Our aim was to assess prognostic factors for occult metastasis and to determine whether current EAU guidelines accurately stratify patients at high risk.Design, setting, and participants
Data of 342 cN0 patients with histologically proven invasive penile squamous cell carcinoma who had undergone the current dynamic sentinel node biopsy (DSNB) protocol were analysed. A complete ipsilateral inguinal lymphadenectomy was only done if the sentinel node was tumour positive.Measurements
The presence of occult metastasis was established by preoperative ultrasound and tumour-positive fine-needle aspiration cytology, tumour-positive sentinel nodes, and groin metastases during follow-up after a negative DSNB procedure. Median follow-up was 31 mo.Results and limitations
Sixty-eight of 342 patients (20%) and 87 of 684 groins (13%) had occult nodal involvement including 6 patients (2%) with a groin metastasis after negative DSNB. Corpus spongiosum invasion, corpus cavernosum invasion, histologic grade, and LVI were each significant prognosticators for occult metastasis on univariate analysis. On multivariate analysis, grade (odds ratio [OR]: 3.3 for intermediate and 4.9 for poor, respectively) and LVI (OR: 2.2) remained predictive factors. In total, 245 patients (72%) were classified high risk according to EAU guidelines. Among them, the incidence of occult metastasis was 23% (57 of 245). A potential limitation of this study is the lack of external review.Conclusions
Histologic grade and LVI are independent prognostic factors for occult metastasis in penile carcinoma. Although both predictors are incorporated into the current EAU guidelines, the stratification of patients needing a lymph node dissection is inaccurate. Approximately 77% of high-risk patients (188 of 245) would have had a negative bilateral inguinal lymphadenectomy. For the time being, DSNB is considered a more suitable staging method than EAU risk stratification for an accurate determination of patients who require lymph node dissection. 相似文献18.
Michael E. Egger MD Glenda G. Callender MD Kelly M. McMasters MD PhD Merrick I. Ross MD Robert C. G. Martin II MD PhD Michael J. Edwards MD Marshall M. Urist MD R. Dirk Noyes MD Jeffrey J. Sussman MD Douglas S. Reintgen MD Arnold J. Stromberg PhD Charles R. Scoggins MD MBA 《Annals of surgical oncology》2013,20(3):956-963
Background
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.Methods
Post hoc analysis was performed of a prospective multi-institutional study of patients with melanoma ≥ 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.Results
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 < 2.1 mm, age < 59 years, no ulceration, and tumor-negative non-SLN) to 14.3 % (men with thickness ≥ 2.1 mm, age ≥ 59 years, ulceration present, and tumor-positive non-SLN). Six distinct subgroups were identified with 5-year OS in excess of 70 %.Conclusions
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. 相似文献19.
McMasters KM Wong SL Edwards MJ Chao C Ross MI Noyes RD Viar V Cerrito PB Reintgen DS 《Annals of surgical oncology》2002,9(2):137-141
Background Completion lymph node dissection (CLND) may not be necessary for some patients because nodal metastasis is rarely detected
beyond the sentinel lymph nodes (SLNs). This analysis was performed to determine, among patients with positive SLNs, the rate
of nodal metastasis found in nonsentinel nodes (NSNs).
Methods This analysis includes patients with positive sentinel nodes, detected by hematoxylin and eosin (H&E) staining or immunohistochemistry
(IHC), who then underwent CLND.
Results This analysis included 274 patients with at least one positive SLN who underwent CLND of 282 involved regional nodal basins.
Of the 282 SLN-positive nodal basins, 45 (16%) were found to have positive NSNs in the CLND specimen. Breslow thickness. Clark
level, presence of ulceration, histological subtype, presence of vertical growth phase, evidence of regression, presence of
lymphovascular invasion, number of positive SLNs, age, sex, and presence of multiple draining nodal basins were not predictive
of positive nodes in the CLND specimen. Patients with SLN metastases detected only by IHC had an equal likelihood of having
positive NSNs as those patients with positive SLNs on H&E examination.
Conclusions No patient population could be identified with minimal risk of non-SLN metastasis. When a positive SLN is identified on either
H&E staining or IHC, CLND should be performed routinely.
Presented at the 54th Annual Cancer Symposium of the Society of Surgical Oncology, Washington, DC, March 15–18, 2001. 相似文献
20.
Sandra L. Wong Mark B. Faries Erin B. Kennedy Sanjiv S. Agarwala Timothy J. Akhurst Charlotte Ariyan Charles M. Balch Barry S. Berman Alistair Cochran Keith A. Delman Mark Gorman John M. Kirkwood Marc D. Moncrieff Jonathan S. Zager Gary H. Lyman 《Annals of surgical oncology》2018,25(2):356-377