Pomen zgodnje limfadenektomije pri bolnikih z melanomom

Lymph node metastases are the most important prognostic factor in the patients with cutaneous melanoma and they are treated with radical lymphadenectomy. In the last 15 years, sentinel lymph node biopsy (SLNB) became the method of choice in staging regional lymph nodes in melanoma patients. The procedure provides the most accurate prognostic information and facilitates early lymphadenectomy in the patients with clinically occult regional metastases, however, therapeutic value of SLNB followed by completion lymph node dissection (CLND) in melanoma patients has not been proved. The reason might be prognostic heterogeneity of patients with positive sentinel lymph node (SN); hence, the aim of this study was to assess survival rates of these patients. For the purpose of this analysis, the patients with stage III melanoma were identified from the prospective melanoma database at the Institute of Oncology Ljubljana, Slovenia, which includes more than 1000 patients. Patients were divided into four groups: • delayed therapeutic lymph node dissection (TLND) • CLND after positive SLNB • synchronous primary melanoma and regional lymph node metastases • lymph node metastases for unknown primaries The worst 5-year overall survival (OS) had the patients with synchronous primary melanoma and regional lymph node metastases. The patients with SN metastases with a diameter of more than 5.0 mm had significantly worse OS than those with delayed TLND, while the patients with SLNB metastases with a diameter of 5.0 mm or less had significantly better OS than those with delayed TLND even after the patients with false positive SLNB (diameter less than 0.3 mm) were excluded. The group of patients with positive SLNB is contaminated with the false positive patients as well as with the patients with more aggressive disease. The majority of SN positive patients, however, have an OS benefit in comparison to the patients with delayed TLND.Ni abstrakta