The clinical significance of sentinel lymph node biopsy in the Chinese patients with cutaneous and acral melanoma

XU Yu; ZHU Huiyan; CHEN Yong

doi:10.19401/j.cnki.1007-3639.2018.11.004

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The clinical significance of sentinel lymph node biopsy in the Chinese patients with cutaneous and acral melanoma

更新时间：2026-01-27

- The clinical significance of sentinel lymph node biopsy in the Chinese patients with cutaneous and acral melanoma
- China Oncology Vol. 28, Issue 11, Pages: 819-826(2018)
- 作者机构：
  
  复旦大学附属肿瘤医院骨软组织外科，复旦大学上海医学院肿瘤学系,上海,200032
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2018.11.004
  CLC：
- Published Online：14 December 2018，
  
  Published：14 December 2018
- 稿件说明：
移动端阅览
徐　宇,朱蕙燕,陈　勇,等. 前哨淋巴结活检在中国皮肤和肢端恶性黑色素瘤患者诊治中的临床意义[J]. 中国癌症杂志, 2018, 28(11): 819-826.

XU Yu, ZHU Huiyan, CHEN Yong. The clinical significance of sentinel lymph node biopsy in the Chinese patients with cutaneous and acral melanoma[J]. China Oncology, 2018, 28(11): 819-826.
徐　宇,朱蕙燕,陈　勇,等. 前哨淋巴结活检在中国皮肤和肢端恶性黑色素瘤患者诊治中的临床意义[J]. 中国癌症杂志, 2018, 28(11): 819-826. DOI： 10.19401/j.cnki.1007-3639.2018.11.004.

XU Yu, ZHU Huiyan, CHEN Yong. The clinical significance of sentinel lymph node biopsy in the Chinese patients with cutaneous and acral melanoma[J]. China Oncology, 2018, 28(11): 819-826. DOI： 10.19401/j.cnki.1007-3639.2018.11.004.

摘要

背景与目的：恶性黑色素瘤近年来在中国发病率呈上升趋势。前哨淋巴结活检（sentinel lymph node biopsy，SLNB）在欧美是皮肤恶性黑色素瘤外科诊治规范的重要环节，但在中国却未广泛开展。中国黑色素瘤具有多肢端亚型、浸润深度厚、溃疡率高和预后差等特点。但中国黑色素瘤外科治疗后的预后仍未明确。该研究旨在分析中国黑色素瘤患者的临床数据，评价SLNB的可行性及其对预后的影响。方法：回顾性分析2009—2017年在复旦大学附属肿瘤医院治疗的无临床淋巴转移和远处转移征象的黑色素瘤患者。每例患者在接受原发病灶扩大切除的同时，进行相应区域淋巴结的SLNB。前哨淋巴结（sentinel lymph node，SLN）的定位通过美兰染色和同位素示踪完成。所有患者术后均进行随访。结果：本研究共纳入452例黑色素瘤患者。平均Breslow浸润深度为3.29 mm，66.4%为肢端病灶，溃疡率达59.7%。SLN阳性率为26.8%，假阴性率为4%，淋巴结总转移率为30.8%。本组患者5年总生存率（overall survival，OS）和无病生存率（disease-free survival，DFS）分别为66.6%和55.8%。SLN状态是显著影响患者预后的独立危险因素，而Breslow浸润深度是预测SLN转移状态的独立危险因素。结论：对于无临床大体转移的中国黑色素瘤患者，应常规开展SLNB。SLN状态是影响复发和总体生存的重要因素，SLNB能提高淋巴结微转移患者的生存，提供准确的临床分期。

Abstract

Background and purpose: Malignant melanoma has become one of the most rapidly increasing malignant diseases in China. Sentinel lymph node biopsy (SLNB) was conducted as a standard surgical procedure for cutaneous melanoma in Western world but not in China nowadays. Compared with those in Western country

Chinese melanomas are characterized by the presence of more acral lesions

thick invasion and high prevalence of ulceration with a poor prognosis. Prognosis of Chinese melanoma after surgery remains unclear. This study aimed to collect clinical data of Chinese melanoma patients so as to evaluate the accessibility of SLNB and summarize the survival outcomes. Methods: Histologically diagnosed primary melanoma with no clinical evidence of local lymph node and distant metastasis

was retrospectively collected from 2009 to 2017 in Fudan University Shanghai Cancer Center. With wide resection of the primary lesion

SLNB was routinely performed in each case. Isotopic tracing or methylene blue dye was applied for identification of the sentinel lymph node (SLN). Follow-ups were taken afterwards. Results: Totally 452 patients were included. The mean Breslow thickness was 3.29 mm with 66.4% acral lesion and 59.7% ulceration. The sentinel lymph node positive rate was 26.8%. Including 4% false-negative rate

the overall lymph node metastatic rate was 30.8%。Five-year overall survival (OS) and disease-free survival (DFS) rate were 66.6% and 55.8%

respectively. SLN status was significantly associated with patients’ outcome. Prognostic analysis showed that Breslow thickness was the independent prognostic factor for SLN metastasis. And SLN status was strongly associated with overall outcomes. Conclusion: SLNB should be employed as a routine surgical procedure for Chinese melanoma with no clinical evidence of metastasis. SLN status is statistically relevant to patient’s disease relapse and overall survival. SLNB can improve the outcome of patients with node micro-metastasis and more importantly provides accurate staging information.

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