Background

Sentinel lymph node biopsy (SLNB) specimens are often obtained from patients for further staging after these patients have undergone melanoma excision. Limited data regarding predictors of SLNB positivity in thin melanoma are available.

Objective

We sought to evaluate predictors of SLNB positivity in thin melanoma.

Methods

Patients with cutaneous melanoma with a Breslow thickness ≤1.00 mm who received a SLNB were identified from the National Cancer Database between 2004 and 2014 (n = 9186). Predictors of SLNB positivity were analyzed using logistic regression.

Results

In a multivariate analysis, patients <60 years of age (P < .001) and Breslow thickness >0.8 mm (P = .03) were at increased risk for positive sentinel lymph node (SLN). Moreover, on multivariate analysis, the presence of dermal mitoses increased the odds of SLN positivity by 95% (odds ratio [OR] 1.95 [95% confidence interval {CI} 1.53-2.5], P < .001), ulceration by 63% (OR 1.63 [95% CI 1.21-2.18], P < .001), and Clark level IV to V by 48% (OR 1.48 [95% CI 1.19-1.85]). Patients without ulceration but with dermal mitoses had 92% (OR 1.92 [95% CI 1.5-2.48], P < .001) increased SLN positivity.

Limitations

Limited survival data are available.

Conclusions

Younger age, a Breslow thickness >0.8 mm, the presence of dermal mitoses, ulceration, and Clark level IV to V are positive predictors of positive SLN. While the new American Joint Committee on Cancer system has removed dermal mitotic rate from staging, continued evaluation of dermal mitotic rate could be valuable for guiding surgical decision making about SLNB.

中文翻译：

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使用国家癌症数据库预测薄型黑色素瘤前哨淋巴结阳性

背景

前哨淋巴结活检（SLNB）标本通常是从这些患者接受了黑色素瘤切除后的患者中获得的，以进行进一步的分期。关于薄型黑色素瘤中SLNB阳性的预测因子的数据有限。

客观的

我们试图评估薄黑色素瘤中SLNB阳性的预测因子。

方法

2004年至2014年间，从国家癌症数据库中鉴定出患有SLslow厚度≤1.00 mm的皮肤黑素瘤患者，并从国家癌症数据库中获得了鉴定（n = 9186）。使用逻辑回归分析SLNB阳性的预测因素。

结果

在多变量分析中，年龄小于60岁的患者（P  <.001）和Breslow厚度大于0.8 mm（P  = .03）的患者前哨淋巴结阳性（SLN）的风险增加。此外，在多变量分析中，真皮有丝分裂的存在使SLN阳性的几率提高了95％（几率[OR] 1.95 [95％置信区间{CI} 1.53-2.5]，P  <.001），溃疡形成了63％ （OR 1.63 [95％CI 1.21-2.18]，P  <.001），Clark IV到V级相差48％（OR 1.48 [95％CI 1.19-1.85]）。无溃疡但有真皮有丝分裂的患者 SLN阳性率增加了92％（OR 1.92 [95％CI 1.5-2.48]，P <.001）。

局限性

有限的生存数据可用。

结论

年龄较小，Breslow厚度> 0.8 mm，真皮有丝分裂，溃疡和克拉克IV级至V级是SLN阳性的阳性指标。尽管新的美国癌症联合委员会系统已从分期中删除了皮肤有丝分裂率，但继续评估皮肤有丝分裂率对于指导关于SLNB的手术决策可能是有价值的。