Značaj kliničko-patoloških prediktora za prisustvo metastaza u stražarskim (sentinel) limfnim čvorovima kod obolelih od melanoma kože

Abstract

Stražarski, sentinel, limfni čvor (SLČ) predstavlja prvi limfni čvor u koji će maligni epitelni tumor metastazirati. Prisustvo metastaze u SLČ smatra se najvažnijim faktorom u stažiranju bolesti, njenom lečenju i kontroli. Ispitivanje SLČ kod melanoma kože i karcinoma dojke postalo je standard u dijagnostici preporučen u TNM (UICC, AJCC) klasifikaciji. Cilj: Glavni cilj ovog istraživanja je da se utvrde klinički i patološki prediktori primarnog melanoma za prisustvo patološki verifikovanih metastaza u SLČ kod pacijenata sa melanomom kože i tankim melanomom ≤1mm (stara TNM klasifikacija), odnosno ≤0,8mm (nova TNM klasifikacija). Materijal i Metode: Ova retrospektivno/prospektivna studija je sprovedena na 148 pacijenta sa dijagnozom primarnog melanoma. Za određivanje značaja u predikciji pozitivnih SLČ u istraživanje su bili uključeni klinički parametri (uzrast, pol i lokalizacija primarnog tumora), kao i patohistološki parametri (prisustvo ulceracija, mitotski indeks, nivo po Klarku, debljina tumora po Breslovu, prisustvo regresije i limfovaskularna invazija), dok je, pored ovih kliničko-patoloških parametara, za procenu povezanosti sa većim hazardom za pojavu relapsa bolesti bila uključena i SLČ pozitivnost. Metodom univarijantne logističke regresione analize ispitivana je povezanost između prediktivnih parametara i pozitivnog SLČ. Za procenu debljine tumora po Breslovu, kod koje bi se mogao očekivati pozitivni SLČ, korišćena je metodologija ROC krive. Za analizu vremena do pojave prvog relapsa obolelih od melanoma kože korišćena je Kaplan Meierova metoda. Za procenu funkcije do prvog relapsa u zavisnosti od karakteristika pacijenata i patohistoloških karakteristika tankog melanoma primenjen je Log Rank test. Univarijantni Coxov regresioni model sa 95% intervalom poverenja korišćen je za pronalaženje nezavisnog prediktora relapsa kod osoba obolelih od melanoma kože...

Sentinel lymph node (SLN) is the first node in which the tumor will metastasize. The presence of metastasis in the SLN is considered the most important factor in disease staging, treatment and control. Examination of SLN in skin melanoma and breast cancer has become a standard in diagnosis and recccomended in TNM (UICC, AJCC) classification. Aim: The main aim of this study is to determine the clinical and pathological predictors of primary melanoma for the presence of pathologically verified metastases in SLNs in patients with skin melanoma and thin melanoma ≤1mm (old TNM classification) or ≤0.8mm (new TNM classification). Materials and methods: This retrospective study was conducted on 148 patients. To determine the prediction of positive SLN, the research included clinical parameters (age, sex and localization of the primary tumor), as well as pathological parameters (presence of ulcerations, mitotic index, Clark classification, Breslow tumor thickness, presence of regression and lymphovascular invasion). Beside these parameters for the analysis of first relapse of melanoma skin patients SLN positivity was also included. The ROC curve was used to estimate Breslow tumor thickness in which a positive SLN could be expected. For the analysis of first relapse of melanoma skin patients, Kaplan Meier's method was used. Log Rank test was applied for evaluation of the first relapse of melanoma skin patients, depending on the characteristics of patients and the pathohistological characteristics of thin melanoma. For identification of the independent relapse predictor in melanoma skin patients a univariate Cox regression model with a 95% confidence interval was used. Results: Statistically significant predictors of SLN positivity were higher level of Breslow tumor thickness and higher Clark's level (p≤0.05), presence of ulceration and higher mitotic index (6 mitosis / mm2) (p <0.001). ROC curve analysis showed that the Breslow tumor thickness of 2.9 mm is a cut off value of SLN positivity (sensitivity 86%, specificity 67%)...