Odnos debljine melanoma i debljine kože kao prognostički pokazatelj metastaza u sentinel limfnom čvoru [Melanoma thickness and skin thickness ratio as the prognostic factor of sentinel lymph node metastasis]

Rudman, Franjo (2010) Odnos debljine melanoma i debljine kože kao prognostički pokazatelj metastaza u sentinel limfnom čvoru [Melanoma thickness and skin thickness ratio as the prognostic factor of sentinel lymph node metastasis]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Sentinel lymph node is the most significant prognostic factor in melanoma, that harbors metastasis in 20% of cases. There is no prognostic factor that takes into consideration skin thickness and melanoma thickness. In 120 patients treated for melanoma from 2005 to 2009, along with standard melanoma prognostic factors, skin thickness was measured and ratio of melanoma thickness and skin thickness was calculated. Influence of melanoma prognostic factors were analyzed on sentinel lymph node positivity. 120 patients (59-M, 61-F) average age 55,9 years had most of melanomas localized on trunk (50,8%). Average melanoma thickness was 3,11 mm, ulceration was present in 40 (33,3%), regression in 2 (1,7%), vascular invasion in 7 (5,8%), tumor infiltrating lymphocytes in 14 (11,7%), more than 1 mitosis/mm2 in 3 (2,5%) patients. In 97 patients (80,8%) there was single, while in 23 patients (19,2%) 2 or more draining lymph basains contained sentinel lymph node. 1,61 sentinel lymph node was removed per patient. In 27 (22,5%) patients sentinel lymph node harbored metastasis, in 11 (9,2%) patients isolated tumor cells were found. Melanoma thickness was most significant predictor of metastasis in sentinel lymph node (p=0,00001), followed by melanoma thickness and skin thickness ratio (p=0,00022) and ulceration (p=0,007) in univariate analysis. In multivariate analysis no prognostic factor was significant. ROC analysis showed more specificity and sensitivity for 97 melanoma thickness (0,781) than for melanoma thickness and skin thickness ratio (0,723). Melanoma thickness and skin thickness ratio is significant prognostic factor in melanoma, although melanoma thickness is the most significant prognostic factor in melanoma, ulceration is important prognostic factor but not so significant as former two.

Abstract in Croatian

Sentinel limfni čvor najvažniji je prognostički pokazatelj melanoma koji je pozitivan u 20% bolesnika. Postoje brojni prognostički pokazatelji metastaza u sentinel limfnome čvoru, ali ne uzimaju u obzir odnos debljine kože i debljine melanoma. U 120 bolesnika s melanomom kože od 2005. do 2009. godine uz standardne prognostičke pokazatelje melanoma određivana je i debljina kože, te omjer debljine melanoma i debljine kože. Analiziran je utjecaj prognostičkih pokazatelja na metastaze u sentinel limfnome čvoru. U bolesnika (M-59, Ž-61) srednje dobi 55,9 godina, najčešće lokalizacije melanoma su na trupu (50,8%), prosječne debljine melanoma 3,11 mm. Ulceracija je prisutna u 40 (33,3%), regresija tumora u 2 (1,7%), vaskularna invazija u 7 (5,8%), limfocitna infiltracija tumora u 14 (11,7%), više od 1 mitoze/mm2 u 3 (2,5%) bolesnika. U 97 (80,8%) bolesnika bila je samo jedna regija u kojoj se nalazio sentinel limfni čvor, dok je u preostalih 23 (19,2%) bolesnika bilo dvije ili više drenažnih limfnih regija. U prosjeku je odstranjen 1,61 limfni čvor po bolesniku. U 27 (22,5%) bolesnika metastaze su bile prisutne u sentinel limfnom čvoru, a u 11 (9,2%) bolesnika izolirane tumorske stanice. Na prisutnost metastaze u sentinel limfnome čvoru univarijatnom analizom statistički su bile značajne debljina melanoma (p=0,00001), omjer debljine melanoma i debljine kože (p=0,00022) te ulceracija (p=0,007). U multivarijatnoj analizi niti jedan parametar nije bio statistički značajan. Analizom omjera specifičnosti i senzitivnosti debljina melanoma je veće specifičnosti i senzitivnosti (0,781) nego omjer debljine melanoma i debljine kože (0,723). 95 Zaključno, univarijatnom analizom omjer debljine melanoma i debljine kože statistički je značajan prognostički pokazatelj prisutnosti metastaze u sentinel limfnome čvoru. Debljina melanoma je najznačajniji pokazatelj metastaza u sentinel limfnome čvoru, a i ulceracija je statistički značajan pokazatelj, iako s manjom statističkom značajnošću nego prethodna dva.

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