前哨淋巴结活检在皮肤型和肢端型黑色素瘤临床诊疗中的价值

邹孜瑊; 孙伟; 胡涂; 王春萌; 严望军; 罗志国; 刘欣; 钟景钦; 林馨怡; 徐宇; 陈勇

doi:10.19401/j.cnki.1007-3639.2022.12.004

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前哨淋巴结活检在皮肤型和肢端型黑色素瘤临床诊疗中的价值

专题论著 | 更新时间：2025-12-31

- 前哨淋巴结活检在皮肤型和肢端型黑色素瘤临床诊疗中的价值
- Clinical value of sentinel lymph node biopsy in patients with cutaneous and acral melanoma
- 中国癌症杂志 2022年32卷第12期页码：1168-1177
- 作者机构：
  
  1. 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
  2. 复旦大学附属肿瘤医院消化肿瘤内科，复旦大学上海医学院肿瘤学系，上海 200032
  3. 复旦大学附属肿瘤医院头颈及神经内分泌肿瘤内科，复旦大学上海医学院肿瘤学系，上海 200032
- 作者简介：
  
  [ "邹孜瑊（ORCID: 0000-0002-4891-478X），硕士研究生在读。" ]
  陈勇（ORCID: 0000-0002-7188-4566），主任医师，复旦大学附属肿瘤医院骨软组织外科副主任。
- 基金信息：
  
  国家自然科学基金面上项目(82272857);国家自然科学基金(81802636);临港实验室基金(LG-QS-202205-11);上海市科学技术委员会科研计划(19411951700)
- DOI：10.19401/j.cnki.1007-3639.2022.12.004
  中图分类号： R739.5
- 收稿：2022-11-02，
  
  修回：2022-12-01，
  
  纸质出版：2022-12-30
- 稿件说明：
移动端阅览
邹孜瑊, 孙伟, 胡涂, 等. 前哨淋巴结活检在皮肤型和肢端型黑色素瘤临床诊疗中的价值[J]. 中国癌症杂志, 2022,32(12):1168-1177.

Zijian ZOU, Wei SUN, Tu HU, et al. Clinical value of sentinel lymph node biopsy in patients with cutaneous and acral melanoma[J]. China Oncology, 2022, 32(12): 1168-1177.
邹孜瑊, 孙伟, 胡涂, 等. 前哨淋巴结活检在皮肤型和肢端型黑色素瘤临床诊疗中的价值[J]. 中国癌症杂志, 2022,32(12):1168-1177. DOI： 10.19401/j.cnki.1007-3639.2022.12.004.

Zijian ZOU, Wei SUN, Tu HU, et al. Clinical value of sentinel lymph node biopsy in patients with cutaneous and acral melanoma[J]. China Oncology, 2022, 32(12): 1168-1177. DOI： 10.19401/j.cnki.1007-3639.2022.12.004.

摘要

背景与目的：

前哨淋巴结活检（sentinel lymph node biopsy，SLNB）是评估皮肤型和肢端型黑色素瘤区域淋巴结转移情况及病理学分期的重要手段。SLNB作为外科诊疗规范的重要环节，已在各大诊疗指南中被推荐，也已在中国临床应用近10年。自2017年靶向和免疫治疗应用于中国黑色素瘤治疗领域，患者预后得到显著改善。本研究旨在分析复旦大学附属肿瘤医院近5年恶性黑色素瘤患者的临床资料，评估在新药治疗时代前哨淋巴结（sentinel lymph node，SLN）状态在临床应用的价值和对预后的影响。

方法：

对2017—2021年在复旦大学附属肿瘤医院黑色素瘤诊治中心接受诊治的381例恶性黑色素瘤患者的临床资料进行回顾性分析。每例患者均接受原发灶扩大切除和相应的SLNB，手术后随访至少6个月。SLN定位使用美兰染色或同位素示踪。

结果：

本研究共入组381例恶性黑色素瘤患者，平均Breslow浸润深度为3.10 mm，69.8%为肢端型，溃疡率为57.1%，SLN阳性率为34.6%，中位无复发生存率（relapse-free survival，RFS）为17个月。SLN状态是显著影响患者预后的独立危险因素。在N

和T

亚组，SLN活检数

2枚的患者具有更好的RFS。接受完整的区域淋巴结清扫（complete lymph node dissection，CLND）和未清扫患者的RFS差异无统计学意义，在SLN活检数

2枚和SLN微转移直径

1 mm的亚组未清扫者反而具有更优的RFS。

结论：

SLN状态仍是影响临床无显性转移的黑色素瘤预后的重要因素，对于恶性黑色素瘤患者应常规开展SLNB，在保证微创的前提下，提高SLN定位的准确性，保证SLNB充分。SLN阳性后行即刻CLND对于皮肤型和肢端型黑色素瘤患者未能带来进一步的预后改善。

Abstract

Background and purpose:

For cutaneous and acral malignant melanoma

sentinel lymph node biopsy (SLNB) is an effective tool to evaluate the situation of regional lymph node metastasis and to determine the pathological stage. As an important part of the standard procedure for surgical diagnosis and treatment

SLNB has been recommended in major guidelines and already has a ten-year clinical application. Since the introduction of targeted therapy and immune therapy for malignant melanoma in 2017

the prognosis of patients has been significantly improved. This study aimed to collect the clinical data of Chinese malignant melanoma cases in recent five years so as to discover

in the era of new drug treatment

the significance of sentinel lymph node (SLN) status in clinical application and its influence on survival outcome.

Methods:

Data of 381 patients with histologically diagnosed malignant melanoma were retrospectively collected from 2017 to 2021 in Fudan University Shanghai Cancer Ce

nter. SLNB was performed with wide resection of the primary lesion for each case

and follow-ups of at least 6 months were taken afterwards. Lymphoscintigraphy or methylene blue dye was applied for identification of SLN.

Results:

A total of 381 patients were included. The mean Breslow thickness was 3.10 mm

among the 381 patients

69.8% with acral lesion

59.7% with ulceration

34.6% with positive SLN

and the median relapse-free survival (RFS) was 17 months. Patient’s survival was significantly influenced by SLN status. Patients with more than 2 biopsied SLN had significantly better RFS in subgroups of N

stage and T

stage. There was no significant difference in RFS between patients who received complete lymph node dissection (CLND) and those who did no

and the latter even showed better RFS in subgroups of SLN biopsied number

2 and SLN micrometastasis diameter

1 mm.

Conclusion:

SLN status remained an important factor influencing the prognosis of melanoma cases with no clinical evidence of significant metastasis

and SLNB should be applied as a routine surgical procedure for malignant melanoma patients. While keeping the operation minimally invasive

the accuracy of SLN locating should be improved

and the sufficiency of biopsy should be ensured. Immediate CLND provides no improvement in the prognosis of cutaneous and acral melanoma patients with positive SLN status.

关键词

Keywords

references

World Health Organization (WHO) . The Global Cancer Observatory: Cancer Today [EB/OL ] . [ 2022 - 07 - 01 ] https://gco.iarc.fr/today/home https://gco.iarc.fr/today/home https://gco.iarc.fr/today/home .

BAI R H , HUANG H , LI M M , et al . Temporal trends in the incidence and mortality of skin malignant melanoma in China from 1990 to 2019 [J ] . J Oncol , 2021 , 2021 : 9989824.

CHI Z H , LI S M , SHENG X N , et al . Clinical presentation, histology, and prognoses of malignant melanoma in ethnic Chinese: a study of 522 consecutive cases [J ] . BMC Cancer , 2011 , 11 : 85 . DOI: 10.1186/1471-2407-11-85 http://doi.org/10.1186/1471-2407-11-85

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 Y , ZHU H Y , CHEN Y , et al . The clinical significance of sentinel lymph node biopsy in the Chinese patients with cutaneous and acral melanoma [J ] . China Oncol , 2018 , 28 ( 11 ): 819 - 826 .

WEN X Z , LI D D , ZHAO J J , et al . Time-varying pattern of recurrence risk for localized melanoma in China [J ] . World J Surg Oncol , 2020 , 18 ( 1 ): 6 . DOI: 10.1186/s12957-019-1775-5 http://doi.org/10.1186/s12957-019-1775-5

WEI X T , WU D , CHEN Y , et al . Prognostic value of ulceration varies across Breslow thicknesses and clinical stages in acral melanoma: a retrospective study [J ] . Br J Dermatol , 2022 , 186 ( 6 ): 977 - 987 . DOI: 10.1111/bjd.21026 http://doi.org/10.1111/bjd.21026

CHERAGHLOU S , UGWU N , GIRARDI M . Sentinel lymph node biopsy positivity in patients with acral lentiginous and other subtypes of cutaneous melanoma [J ] . JAMA Dermatol , 2022 , 158 ( 1 ): 51 - 58 . DOI: 10.1001/jamadermatol.2021.4812 http://doi.org/10.1001/jamadermatol.2021.4812 https://jamanetwork.com/journals/jamadermatology/fullarticle/2786976 https://jamanetwork.com/journals/jamadermatology/fullarticle/2786976

PAMEIJER C R , LEUNG A , NEVES R I , et al . Indocyanine green and fluorescence lymphangiography for sentinel node identification in patients with melanoma [J ] . Am J Surg , 2018 , 216 ( 3 ): 558 - 561 . DOI: S0002-9610(17)31428-9 http://doi.org/S0002-9610(17)31428-9

PUZA C J , JOSYULA S , TERANDO A M , et al . Does the number of sentinel lymph nodes removed affect the false negative rate for head and neck melanoma? [J ] . J Surg Oncol , 2018 , 117 ( 7 ): 1584 - 1588 . DOI: 10.1002/jso.25025 http://doi.org/10.1002/jso.25025

FARIES M B , THOMPSON J F , COCHRAN A J , et al . Completion dissection or observation for sentinel-node metastasis in melanoma [J ] . N Engl J Med , 2017 , 376 ( 23 ): 2211 - 2222 . DOI: 10.1056/NEJMoa1613210 http://doi.org/10.1056/NEJMoa1613210 http://www.nejm.org/doi/10.1056/NEJMoa1613210 http://www.nejm.org/doi/10.1056/NEJMoa1613210

LEITER U , STADLER R , MAUCH C , et al . Final analysis of DeCOG-SLT trial: no survival benefit for complete lymph node dissection in patients with melanoma with positive sentinel node [J ] . J Clin Oncol , 2019 , 37 ( 32 ): 3000 - 3008 . DOI: 10.1200/JCO.18.02306 http://doi.org/10.1200/JCO.18.02306

SUN W , XU Y , YANG J L , et al . The prognostic significance of non-sentinel lymph node metastasis in cutaneous and acral melanoma patients-a multicenter retrospective study [J ] . Cancer Commun (Lond) , 2020 , 40 ( 11 ): 586 - 597 .

ULMER A , DIETZ K , WERNER-KLEIN M , et al . The sentinel lymph node spread determines quantitatively melanoma seeding to non-sentinel lymph nodes and survival [J ] . Eur J Cancer , 2018 , 91 : 1 - 10 . DOI: S0959-8049(17)31458-2 http://doi.org/S0959-8049(17)31458-2

MARCHETTI M A , DUSZA S W , BARTLETT E K . Utility of a model for predicting the risk of sentinel lymph node metastasis in patients with cutaneous melanoma [J ] . JAMA Dermatol , 2022 , 158 ( 6 ): 680 - 683 . DOI: 10.1001/jamadermatol.2022.0970 http://doi.org/10.1001/jamadermatol.2022.0970 https://jamanetwork.com/journals/jamadermatology/fullarticle/2791592 https://jamanetwork.com/journals/jamadermatology/fullarticle/2791592

TROPEA S , DEL FIORE P , MAURICHI A , et al . The role of sentinel node tumor burden in modeling the prognosis of melanoma patients with positive sentinel node biopsy: an Italian melanoma intergroup study ( N = 2 086) [J ] . BMC Cancer , 2022 , 22 ( 1 ): 610 . DOI: 10.1186/s12885-022-09705-y http://doi.org/10.1186/s12885-022-09705-y https://doi.org/10.1186/s12885-022-09705-y https://doi.org/10.1186/s12885-022-09705-y

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