Собственный опыт, практическое значение и перспективы биопсии сигнальных лимфатических узлов в РФ

Abstract

Sentinel lymph node biopsy (SLNB) is a standard component of I and II clinical stage skin melanoma staging. Patients with IIB, IIC, and IIIB stages have similar prognosis, but different tactic. The KEYNOTE-716 study shows a 37,5% reduction in the risk of local recurrence in stage IIB, IIC with adjuvant treatment with pembrolizumab compared with observation. The NCCN recommendations version 2.2023 has already introduced the possibility of SLNB refusing in patients with skin melanoma clinical stage IIB, IIC and prescribing pembrolizumab in the adjuvant treatment. The study included patients over 18 years old with clinical stage IB, IIA, IIB, or IIC skin melanoma – AJCC, 8th edition, 234 males (31%) and 521 females (69%). Metastasis was detected in 17.2% (n = 130). Patients in categories T1a, T1b and T2a were 7.4% (n = 56), 16.5% (n = 125) and 19.6% (n = 148). Metastaticall sentinel lymph node (SLN) was found in 10% of these categories, in 100% it was the only lymph node with metastasis. 585 patients (77.5%) agreed to participate in the survey. All patients are under observation. In 55 (9.4%) cases skin melanoma progression occurred: 27 (4.6%) in the lymph nodes, 8 (1.3%) – satellite and transit metastases, and 20 (3.4%) – distant metastases (lungs – 7, liver – 5, brain – 3, bones, other – 5). A lethal outcome was recorded in 5 cases, the relatives refused to report the cause of death. New information raises the potential issue of de-escalation of surgical treatment and expansion of indications for systemic treatment of patients with clinical stage IB, IIB, IIC skin melanoma