Schildwachtklierbiopsie bij het melanoom: prognostische betekenis en nadelen bij 300 patiënten
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Onderzoek
19-08-2005
M. de Vries, P.L. Jager, A.J.H. Suurmeijer, J.T.M. Plukker, R.J. van Ginkel en H.J. Hoekstra

Sentinel lymph node biopsy for melanoma: prognostic value and disadvantages in 300 patients

The aim of this study was to evaluate the advantages and disadvantages of sentinel lymph node biopsy (SLNB) in patients with cutaneous melanoma.

Design.

Descriptive follow-up study.

Method.

In the period 1995-2004, 300 patients with cutaneous melanoma (Breslow thickness: ≥ 1.0 mm) underwent SLNB and, in case of a tumour-positive result, regional lymph node dissection. Results of the SLNB procedure, postoperative complications, follow-up, recurrences, disease-free survival and disease-specific survival were evaluated.

Results.

The SLNB detection rate was 99. 85 patients had a tumour-positive SLNB (28) and underwent completion regional lymph node dissection; 215 patients underwent SLNB alone. The rate of postoperative complications after SLNB was 7. With a median follow up of 51 months, the false-negative rate was 11. The recurrence rate was 23 (SLNB negative: 19; SLNB positive 34; p = 0.005). In-transit metastases were found in 4 of the SLNB-negative group and in 20 of the SLNB-positive group (p < 0.001). The 5-year disease-free survival and disease-specific survival rates were 79 and 86, respectively, in SLNB-negative patients and 57 and 71, respectively, in SLNB-positive patients. Multivariate analysis showed that the independent prognostic factors for disease-free survival were presence of ulceration (p < 0.001) and SLNB positivity (p < 0.01). Prognostic factors for overall survival were presence of ulceration (p < 0.001) and male sex (p < 0.05), but not the SLNB results. Multivariate analysis also showed that SLNB positivity (p < 0.001) and presence of ulceration (p < 0.01) were independent prognostic factors for developing in-transit metastases.

Conclusion.

SLNB in patients with cutaneous melanoma is still only of prognostic value since survival benefit is not proven. Disadvantages of SLNB were the false-negative rate, the possibility of an increased risk of in-transit metastases in SLNB-positive patients, and postoperative complications. These must be kept in mind when offering patients SLNB.

Ned Tijdschr Geneeskd 2005;149:1845-51