全面分析临床局部皮肤黑色素瘤手术后的转移性疾病。

IF 9.9 1区 医学 Q1 ONCOLOGY
Christina S Boutros, Hanna Kakish, Omkar S Pawar, Alexander W Loftus, John B Ammori, Jeremy Bordeaux, Ankit Mangla, Iris Sheng, Gary Schwartz, Luke D Rothermel, Richard S Hoehn
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引用次数: 0

摘要

简介:NCCN认为所有前哨淋巴结活检阳性的无症状黑色素瘤患者都应进行 "基线分期"(全身CT或PET扫描+/-脑磁共振成像)。这些检查的真实结果尚不清楚:我们利用全国癌症数据库(2012-2020 年)创建了成人恶性黑色素瘤患者队列,模拟三种常见情况:(1)临床结节阴性,前哨淋巴结阳性(SLNB[+]);(2)临床结节阴性,前哨淋巴结阴性(SLNB[-]);(3)临床结节阳性,确诊淋巴结转移(cN[+]和pN[+])。根据主要特征构建了多变量回归、监督决策树和提名图,以评估转移风险:10371例患者为SLNB[+],55172例患者为SLNB[-],4012例患者为cN[+]和pN[+]。有任何转移性疾病(脑转移)的患者比例如下:SLNB[+]:1.4%(0.3%);SLNB[-] 0.3%( 4、溃疡和淋巴管侵犯与转移性疾病的风险较大有关。针对 SLNB[+] 和 SLNB[-] 患者的监督决策树发现,只有 T4 肿瘤或 T2/T3 肿瘤伴有溃疡和 LVI,转移风险大于 2%。大多数组别的转移风险可忽略不计(结论:这是首个指导肿瘤转移治疗的大型分析:这是第一份指导皮肤黑色素瘤成像应用的大型分析报告。在临床结节阴性的患者中,转移性疾病并不常见,脑转移也极为罕见。进一步的研究可促进根据个体风险因素制定有针对性的转移检查方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Comprehensive Analysis of Metastatic Disease following Surgery for Clinically Localized Cutaneous Melanoma.

Introduction: The NCCN considers "baseline staging" (whole body CT or PET scan +/- brain MRI) for all asymptomatic melanoma patients with a positive sentinel lymph node biopsy. The true yield of these workups is unknown.

Methods: We created cohorts of adult malignant melanoma patients, using the National Cancer Database (2012-2020) to mimic three common scenarios: (1) clinically node negative, with positive sentinel lymph node(s) (SLNB[+]); (2) clinically node negative, with negative sentinel lymph node(s) (SLNB[-]); (3) clinically node positive with confirmed lymph node metastases (cN[+] and pN[+]). Multivariable regression, supervised decision trees, and nomograms were constructed to assess the risk of metastases based on key features.

Results: 10,371 patients were SLNB[+], 55,172 were SLNB[-], and 4,012 were cN[+] and pN[+]. The proportion of patients with any metastatic disease (brain metastases) were as follows: SLNB[+]: 1.4% (0.3%); SLNB[-] 0.3% (<0.1%); cN[+] and pN[+] 11.6% (1.6%). On multivariable regression, Breslow depth > 4, ulceration, and lymphovascular invasion were associated with greater risk of metastatic disease. A supervised decision tree for SLNB[+] and SLNB[-] patients found the only groups with >2% risk of metastases were T4 tumors or T2/T3 tumors with ulceration and LVI. Most groups had a negligible risk (<0.1%) of brain metastases.

Conclusion: This is the first large analysis to guide the use of imaging for cutaneous melanoma. Among clinically node negative patients, metastatic disease is uncommon and brain metastases are exceedingly rare. Further investigation could promote a tailored approach to metastatic workups guided by individual risk factors.

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来源期刊
CiteScore
17.00
自引率
2.90%
发文量
203
审稿时长
4-8 weeks
期刊介绍: The Journal of the National Cancer Institute is a reputable publication that undergoes a peer-review process. It is available in both print (ISSN: 0027-8874) and online (ISSN: 1460-2105) formats, with 12 issues released annually. The journal's primary aim is to disseminate innovative and important discoveries in the field of cancer research, with specific emphasis on clinical, epidemiologic, behavioral, and health outcomes studies. Authors are encouraged to submit reviews, minireviews, and commentaries. The journal ensures that submitted manuscripts undergo a rigorous and expedited review to publish scientifically and medically significant findings in a timely manner.
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