预防性淋巴结清扫在恶性黑色素瘤治疗中的价值  

Evaluation of Prophylactic Lymph Node Dissection in Management of Malignant Melanoma

作　　者：肖继伟[1] 彭俊平[1] 唐定波[1] 

机构地区：[1]四川省肿瘤医院骨科,成都610041

出　　处：《肿瘤防治研究》2008年第10期730-733,共4页Cancer Research on Prevention and Treatment

摘　　要：目的探讨预防性区域淋巴结清扫在恶性黑色素瘤治疗中的价值。方法56例WHO临床分期Ⅰ期即区域淋巴结不能扪及的肢体恶性黑色素瘤随机分为清扫组和对照组，清扫组30例施行预防性区域淋巴结清扫，而对照组26例不进行预防性区域淋巴结清扫，两组均以至少2cm的边界对原发灶做广泛切除和术后应用相同方案的辅助治疗。用Kaplan-Meier法统计清扫组和对照组的生存率，以Log-rank检验比较两组的生存曲线。结果全部病例获得11月-84月随访，中位随访期43．5月，清扫组和对照组5年生存率分别为64．79％和33．68％，清扫组生存率较对照组高，生存曲线Log—Rank检验比较（P=0．0414）显示两组间差异有统计学意义。结论预防性区域淋巴结清扫有助于提高WHO分期Ⅰ期的恶性黑色素瘤病例的生存率。Objective To evaluate the role of prophylactic regional lymph node dissection （LND） in the management of primary malignant melanoma. Methods 56 patients with WHO clinical stage Ⅰ malignant melanoma in the extremity, who had no palpable regional lymph node, were randomly divided into two groups. There were 30 patients in LND group who underwent excision of primary tumor plus LND, whereas 26 patients in control group who underwent excision of primary tumor alone. The excisions of primary tumor for two groups were the wide resections with a margin of at least 2 cm. All patients had the same modality of adjuvant therapy after operation. The overall survival rates for the 2 groups were estimated with the Kaplan-Meier method and the survival curves were compared using the log-rank test. Results The median follow-up for all patients was 43.5 months （range, 11-84 months）. The five-year overall survival rates were 64. 79% for LND group and 33.68%for control group, respectively. The Log rank test （P = 0. 0414） showed that there was a statistically significant difference between the two groups. Conclusion Prophylactic regional lymph node dissection may improve the survival rate of surgical management for patients with WHO stage I malignant melanoma in the extremity.

关 键 词：恶性黑色素瘤 治疗 区域淋巴结清扫 

分 类 号：R739.5[医药卫生—肿瘤] R730.56[医药卫生—临床医学]