Abstract
7539 Background: The benefit of LM/SL in thin (≤1 mm pT1) and thick (>4 mm - pT4) CM pts is controversial. We analyzed the results of LM/SL in these pts at one institution. Methods: We analyzed a group of consecutive pts with CM thickness ≤ 1 mm (A, 176 pts, range: 0.5mm to 1mm) and > 4mm (B, 223 pts, range: 4.1 - 58.0mm) selected from database of 832 pts who underwent LM/SL using the technetium radiocolloid combined with blue dye technique from 06/1996 to 04/2003. The median follow-up time was 30 months. Results: The sentinel node(s) (SLN) were successfully identified in 98.3% of pts in A and in 96.9% in B. SLN metastases in A were found in significantly (p<0.0001) lower number of 14 pts (7.9%, the thickness for positive SLN ranged from 0.75 mm to 1.0 mm and only 2 pts had evidence of ulceration) as compared with 79 pts (35.4%) in B (thickness for positive SLN ranged from 4.2 mm to 35.0 mm and 69 pts with ulceration). The false-negative LM/SL rate was 1.9% (3/162) in A and 6.2% (9/144) in B (p=0.048). All node-positive pts underwent radical lymph node dissection. Lymph nodes other than SLNs were found to contain metastases in 21.4% (3/14) in group A and in 45.6% (36/79) in group B (p=0.09). The estimated 5-year overall survival (OS) rate was 94% for A and 58% for B (p<0.0001). In A we did not detect statistically significant differences for OS between SLN-positive and negative pts (5-year OS rate 95% and 93%, respectively), however SLN positive pts had significantly lower disease free survival - DFS (5-year ratio: 94%% and 85%, respectively, p=0.01). In B 5-year OS rate was 75% for SLN negative pts and 31% for SLN positive pts (p=0.00001) and 5-year DFS ratio was 63% and 33% (p=0.00002). SLN status was an independent prognostic factor for both OS and DFS by univariate and multivariate analyses in B, but not in A. Conclusions: LM/SL should be offered to all pts with thick (pT4 > 4 mm) CM, as well as to pts with pT1 CM thicker than 0.75 mm. In thick CM the regional lymph node status is the strongest predictor for survival. LM/SL in thick CM is connected with a higher false negative results rate when compare with thin CM, what can be explained by wider excision of advanced primaries. No significant financial relationships to disclose.
Published Version
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