DOI QR코드

DOI QR Code

Observational approach on regional lymph node in cutaneous melanomas of extremities

  • Jang, Bum-Sup (Department of Radiation Oncology, Seoul National University Hospital) ;
  • Eom, Keun-Yong (Department of Radiation Oncology, Seoul National University Bundang Hospital) ;
  • Cho, Hwan Seong (Department of Orthopaedic Surgery, Seoul National University Bundang Hospital) ;
  • Song, Changhoon (Department of Radiation Oncology, Seoul National University Bundang Hospital) ;
  • Kim, In Ah (Department of Radiation Oncology, Seoul National University Bundang Hospital) ;
  • Kim, Jae-Sung (Department of Radiation Oncology, Seoul National University Bundang Hospital)
  • 투고 : 2018.11.13
  • 심사 : 2019.03.11
  • 발행 : 2019.03.31

초록

Purpose: We evaluated failure pattern and treatment outcomes of observational approach on regional lymph node (LN) in cutaneous melanoma of extremities and sought to find clinico-pathologic factors related to LN metastases. Material and Methods: We retrospectively reviewed 73 patients with cutaneous melanoma of extremities between 2005 and 2016. If preoperative 18-F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) findings were non-specific for regional LNs, surgical resection of primary tumors with adequate margins was performed without sentinel lymph node biopsy (SLNB) and/or complete lymph node dissection (CLND), irrespective of tumor thickness or size. In patients with suspicious or positive findings on PET/CT or CT, SLNB followed by CLND or CLND was performed at the discretion of the surgeon. We defined LN dissection (LND) as SLNB and/or CLND. Results: With a median follow-up of 38 months (range, 6 to 138 months), the dominant pattern of failure was regional failure (17 of total 23 events, 74%) in the observation group (n = 56). Pathologic LN metastases were significant factor for poor regional failure-free survival (hazard ration [HR] = 3.21; 95% confidence interval [CI], 1.03-10.33; p = 0.044) and overall survival (HR = 3.62; 95% CI, 1.02-12.94; p = 0.047) in multivariate analysis. In subgroup analysis for cN0 patients according to the preoperative PET/CT findings, LND group showed the better trend of LRFFS (log rank test, p = 0.192) and RFFS (p = 0.310), although which is not statistically significant. Conclusion: Observational approach on regional LNs on the basis of the PET/CT in patients with cutaneous melanoma of extremities showed the dominant regional failure pattern compared to upfront LND approach. To reveal regional lymph node status, SLND for cN0 patients may of importance in managing cutaneous melanoma patients.

키워드

참고문헌

  1. Markovic SN, Erickson LA, Rao RD, et al. Malignant melanoma in the 21st century, part 1: epidemiology, risk factors, screening, prevention, and diagnosis. Mayo Clin Proc 2007;82:364-80. https://doi.org/10.4065/82.3.364
  2. Chen L, Jin S. Trends in mortality rates of cutaneous melanoma in East Asian populations. PeerJ 2016;4:e2809. https://doi.org/10.7717/peerj.2809
  3. Dummer R, Hauschild A, Lindenblatt N, Pentheroudakis G, Keilholz U; ESMO Guidelines Committee. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015;26 Suppl 5:v126-32. https://doi.org/10.1093/annonc/mdv297
  4. Wrightson WR, Wong SL, Edwards MJ, et al. Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol 2003;10:676-80. https://doi.org/10.1245/ASO.2003.10.001
  5. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med 2014;370:599-609. https://doi.org/10.1056/NEJMoa1310460
  6. National Comprehensive Cancer Network. NCCN Guidelines for treatment of cancer: melanoma [Internet]. Plymouth Meeting, PA: National Comprehensive Cancer Network; c2019 [cited 2019 Mar 15]. Available from: https://www.nccn.org/professionals/physician_gls/default.aspx.
  7. Wong SL, Balch CM, Hurley P, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. J Clin Oncol 2012;30:2912-8. https://doi.org/10.1200/JCO.2011.40.3519
  8. Wong SL, Balch CM, Hurley P, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. Ann Surg Oncol 2012;19:3313-24. https://doi.org/10.1245/s10434-012-2475-3
  9. Egger ME, Stevenson M, Bhutiani N, et al. Should sentinel lymph node biopsy be performed for all T1b melanomas in the new 8(th) Edition American Joint Committee on Cancer Staging System? J Am Coll Surg 2019 Jan 17 [Epub]. http://doi.org/10.1016/j.jamcollsurg.2018.12.030.
  10. Santos-Juanes J, Fernandez-Vega I, Galache Osuna C, Coto-Segura P, Martinez-Camblor P. Sentinel lymph node biopsy plus wide local excision vs. wide location excision alone for primary cutaneous melanoma: a systematic review and metaanalysis. J Eur Acad Dermatol Venereol 2017;31:241-6. https://doi.org/10.1111/jdv.13824
  11. van der Ploeg AP, Haydu LE, Spillane AJ, et al. Outcome following sentinel node biopsy plus wide local excision versus wide local excision only for primary cutaneous melanoma: analysis of 5840 patients treated at a single institution. Ann Surg 2014;260:149-57. https://doi.org/10.1097/SLA.0000000000000500
  12. Cordeiro E, Gervais MK, Shah PS, Look Hong NJ, Wright FC. Sentinel lymph node biopsy in thin cutaneous melanoma: a systematic review and meta-analysis. Ann Surg Oncol 2016;23:4178-88. https://doi.org/10.1245/s10434-016-5137-z
  13. Han D, Zager JS, Shyr Y, et al. Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma. J Clin Oncol 2013;31:4387-93. https://doi.org/10.1200/JCO.2013.50.1114
  14. Mozzillo N, Pennacchioli E, Gandini S, et al. Sentinel node biopsy in thin and thick melanoma. Ann Surg Oncol 2013;20:2780-6. https://doi.org/10.1245/s10434-012-2826-0
  15. Schroer-Gunther MA, Wolff RF, et al. F-18-fluoro-2-deoxyglucose positron emission tomography (PET) and PET/computed tomography imaging in primary staging of patients with malignant melanoma: a systematic review. Syst Rev 2012;1:62. https://doi.org/10.1186/2046-4053-1-62
  16. Acland KM, Healy C, Calonje E, et al. Comparison of positron emission tomography scanning and sentinel node biopsy in the detection of micrometastases of primary cutaneous malignant melanoma. J Clin Oncol 2001;19:2674-8. https://doi.org/10.1200/JCO.2001.19.10.2674
  17. Rinne D, Baum RP, Hor G, Kaufmann R. Primary staging and follow-up of high risk melanoma patients with whole-body 18F-fluorodeoxyglucose positron emission tomography: results of a prospective study of 100 patients. Cancer 1998;82:1664-71. https://doi.org/10.1002/(SICI)1097-0142(19980501)82:9<1664::AID-CNCR11>3.0.CO;2-2
  18. Ribero S, Osella-Abate S, Sanlorenzo M, et al. Sentinel lymph node biopsy in thick-melanoma patients (n=350): what is its prognostic role? Ann Surg Oncol 2015;22:1967-73. https://doi.org/10.1245/s10434-014-4211-7
  19. Kachare SD, Singla P, Vohra NA, Zervos EE, Wong JH, Fitzgerald TL. Sentinel lymph node biopsy is prognostic but not therapeutic for thick melanoma. Surgery 2015;158:662-8. https://doi.org/10.1016/j.surg.2015.05.012
  20. Faries MB, Thompson JF, Cochran A, et al. The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the Multicenter Selective Lymphadenectomy Trial (I). Ann Surg Oncol 2010;17:3324-9. https://doi.org/10.1245/s10434-010-1203-0