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对临床局部化皮肤黑色素瘤手术后转移性疾病的综合分析
Christina S Boutros1, Hanna Kakish1, Omkar S Pawar1
1Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Journal of the National Cancer Institute
|September 2, 2024
概括
无症状黑色素瘤的基线分期与阳性哨兵淋巴结活检很少是有益的. 转移性疾病,特别是大脑转移,在节点阴性患者中不常见,这表明需要量身定制的成像方法.
科学领域:
- 在瘤学瘤学.
- 医疗成像医学成像
- 皮肤病学 皮肤病学
背景情况:
- 国家综合癌症网络的指导方针建议对无症状黑色素瘤患者的基线分期,这些患者的哨戒淋巴结活检结果呈阳性.
- 这些广泛的成像工作的诊断产量仍然不清楚.
研究的目的:
- 在无症状黑色素瘤患者中评估基线分期的真实收益率.
- 评估在黑色素瘤分期的不同临床场景中转移性疾病和大脑转移的风险.
主要方法:
- 来自国家癌症数据库 (2012-2020) 的成年恶性黑色素瘤患者的分析.
- 队列被创建以模仿临床结节阴性 (阳性/阴性SLNB) 和结节阳性疾病.
- 用多变量回归,决策树和名图来评估转移风险.
主要成果:
- 在结节阴性患者中,阳性哨兵淋巴结活检 (SLNB),1.4%患有转移性疾病,0.3%患有脑转移.
- 在阴性SLNB的节点阴性患者中,只有0.3%患有转移性疾病,<0.1%患有脑转移.
- 高风险特征包括Breslow深度>4mm,和淋巴血管入侵,特别是在T4或T2/T3瘤中.
结论:
- 转移性疾病在临床结节阴性黑色素瘤患者中不常见,大脑转移非常罕见.
- 当前的基线分期协议可能会导致许多无症状患者不必要的成像.
- 对皮肤黑色素瘤来说,对转移性治疗有必要采用风险因素指导的,量身定制的方法.
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