幸存率与辅助剂选择相对应 哨兵节点 积极的头皮肤黑色素瘤和部黑色素瘤
Sina Dadafarin1, Mohammed A Alvi2,3, Sean T Massa4
1Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
The Laryngoscope
|May 16, 2025
概括
对于头部和部皮肤黑色素瘤患者,阳性哨兵淋巴结活检,免疫疗法使用与更好的生存率有关,而完成淋巴结剖析率有所下降. 治疗决策受到患者人口统计学的影响.
科学领域:
- 在瘤学瘤学.
- 皮肤病学 皮肤病学
- 手术瘤学手术瘤学
背景情况:
- 头部和部皮肤黑色素瘤 (HNCM) 的管理包括哨兵淋巴结活检 (SLNB) 来评估结节转移.
- 在HNCM中阳性SLNB需要进一步的治疗决定,历史上包括完成淋巴结解剖 (CLND) 和越来越多的免疫治疗.
研究的目的:
- 评估SLNB阳性HNCM患者中CLND和免疫疗法的使用变化.
- 确定CLND和免疫治疗对这一患者队列的整体存活时间 (OS) 的影响.
主要方法:
- 对2020年国家癌症数据库 (NCDB) 黑色素瘤档案的回顾性分析,用于原发性HNCM和阳性SLNB的患者.
- 从2012年到2019年追踪CLND和免疫治疗率.
- 多变量考克斯回归分析,以评估治疗选择与OS之间的关联,控制临床人口统计因素.
主要成果:
- 在2016年之后,CLND的发病率显著下降,从66%降至18%,而辅助免疫疗法使用率则上升至大约40%.
- 免疫疗法使用,但不是CLND,独立地与改善的整体存活率相关 (HR 0.65;95% CI 0.45-0.93).
- 与免疫疗法相关的患者因素包括年龄较小,私人保险,收入较高和在特定医疗机构接受治疗.
结论:
- 现代SLNB阳性HNCM的管理已经转向增加免疫疗法和减少CLND.
- 辅助免疫疗法与这些患者的改善生存结果有关.
- 治疗模式表明社会经济和人口因素影响免疫疗法的使用.
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