Survival Outcomes in Upstaged Cutaneous Head and Neck Melanoma With Negative Sentinel Lymph Node Biopsy: A Retrospective Analysis.

Surabhi Sivaratnam, Michael Xie, Phillip Staibano, Sepideh Mohajeri, Kelvin Zhou, Ali Zhang, Raphaelle Koerber, J E M Ted Young, Han Zhang
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Abstract

Background: Biopsy is required to stage cutaneous head and neck melanomas (cHNM), but cHNM can be pathologically upstaged following surgical resection. Here, we evaluated whether upstaged cHNM with negative sentinel lymph node biopsy (SLNB) impacts survival and time to cHNM recurrence.

Methods: We retrospectively analyzed cHNM patients with negative SLNB treated from 2007 to 2014. We included adult cHNM patients with T2a-4a disease at biopsy who underwent SLNB-negative and wide local excision. We extracted patient demographics, treatment details, and survival outcomes. Melanoma-specific survival (MSS) and cHNM recurrence outcomes were analyzed using Cox regression analysis and 95% confidence intervals (95% CI).

Results: Overall, 87 patients met inclusion criteria, 17 of whom were upstaged after definitive treatment. No significant baseline demographic or cHNM differences were observed between groups. Excisional biopsies were most performed (n = 57, 65.5%), yet upstaged patients more frequently underwent shave or punch biopsies. Most cHNM lesions were found on the face (n = 35, 40.2%). Univariable Cox regression revealed significant association between upstaged pathology (unadjusted hazard ratio: 3.20, 95% CI: 1.12-9.16), close margins (unadjusted hazard ratio: 4.95, 95% CI: 1.61-15.20), and worse MSS; however, multivariable Cox regression did not demonstrate any relationship between upstaged pathology or margin status and MSS.

Conclusion: Among patients with pT2-4a, SLNB-negative cHNM, pathological upstaging does not independently predict MSS when adjusted for margin status, but large multicenter prospective cohort studies are needed to further validate these findings.

前哨淋巴结活检阴性的皮肤头颈部黑色素瘤的生存结果:回顾性分析。
背景:皮肤头颈部黑色素瘤(cHNM)的分期需要活检,但cHNM在手术切除后可能在病理上被掩盖。在这里,我们评估了前哨淋巴结活检(SLNB)阴性是否会影响cHNM的生存和复发时间。方法:回顾性分析2007 - 2014年接受SLNB阴性治疗的cHNM患者。我们纳入了活检时患有T2a-4a疾病的成年cHNM患者,他们接受了slnb阴性和广泛的局部切除。我们提取了患者的人口统计资料、治疗细节和生存结果。使用Cox回归分析和95%可信区间(95% CI)分析黑色素瘤特异性生存(MSS)和cHNM复发结果。结果:总体而言,87例患者符合纳入标准,其中17例在最终治疗后被抢镜。各组间未观察到显著的基线人口统计学差异或cHNM差异。切除活检最多(n = 57, 65.5%),而被抢风头的患者更常接受刮胡子或打孔活检。大多数cHNM病变位于面部(n = 35, 40.2%)。单变量Cox回归显示,被抢走的病理(未经校正的风险比:3.20,95% CI: 1.12-9.16)、切缘接近(未经校正的风险比:4.95,95% CI: 1.61-15.20)和更糟的MSS之间存在显著关联;然而,多变量Cox回归并没有显示出抢镜病理或切缘状态与MSS之间的任何关系。结论:在pT2-4a、slnb阴性cHNM患者中,当调整切缘状态时,病理优势并不能独立预测MSS,但需要大型多中心前瞻性队列研究来进一步验证这些发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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