Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphonodectomy and early excision of their nodal disease

被引:96
作者
Kretschmer, L
Hilgers, R
Möhrle, M
Balda, BR
Breuninger, H
Konz, B
Kunte, C
Marsch, WC
Neumann, C
Starz, H
机构
[1] Univ Gottingen, Dept Dermatol, D-37075 Gottingen, Germany
[2] Univ Gottingen, Dept Med Stat, D-37075 Gottingen, Germany
[3] Univ Tubingen, Dept Dermatol, D-72076 Tubingen, Germany
[4] Klinikum Augsburg, Dept Dermatol & Allergol, D-86156 Augsburg, Germany
[5] Univ Munich, Dept Dermatol, D-80337 Munich, Germany
[6] Univ Halle Wittenberg, Dept Dermatol, D-06097 Halle Saale, Germany
关键词
melanoma; lymph node metastases; delayed excision; sentinel lymphonodectomy; prognostic factors;
D O I
10.1016/j.ejca.2003.07.003
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Early versus delayed excision of lymph node metastases is still being assessed in malignant melanoma. In the present retrospective, multicentre study, the outcome of 314 patients with positive sentinel lymphonodectomy (SLNE) was compared with the outcome of 623 patients with delayed lymph node dissection (DLND) of clinically enlarged lymph node metastases. In order to avoid the lead-time bias, survival was generally calculated from the excision of the primary tumour. Survival curves were constructed using the Kaplan-Meier product-limit estimate. Cox's proportional hazards model was used to perform a multivariate analysis of factors related to overall survival. Compared with SLNE and early performed complete lymph node dissection, DLND yielded a significantly higher number of lymph node metastases. Median and mean tumour thickness were nearly identical in the two therapy groups. The estimated 3-year overall survival rate was 80.1 +/- 2.8% ( standard error of the mean (SEM)) in patients with positive SLNs, and 67.6 +/- 1.9% in patients with DLND (5-year survival rates 62.5 +/- 5.5 and 50.2 +/- 5.4%, respectively). The difference between the two survival curves was statistically significant (P=0.002). Using multifactorial analysis, SLNE (P=0.000052), American Joint Committee on Cancer (AJCC) Breslow thickness category (P<0.000001), age (P=0.01) and gender (P=0.028) were independent predictors of overall survival. The location of the primary tumour (P=0.59) was non-significant. Considering only those centres with sufficient data for epidermal ulceration, this risk factor was also significant. In cutaneous malignant melanoma, early excision of lymphatic metastases, directed by the sentinel node procedure, provides a highly significant overall survival benefit. (C) 2003 Elsevier Ltd. All rights reserved.
引用
收藏
页码:212 / 218
页数:7
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