99Tcm-利妥昔单克隆抗体前哨淋巴结活组织检查与皮肤恶性黑色素瘤分期及患者生存期的关系

Abstract

目的 探讨99Tcm-利妥昔单克隆抗体(简称单抗)SLNB在皮肤恶性黑色素瘤分期中的准确性、可行性及与患者生存期的关系.方法 选取2008年6月至2014年11月89例确诊皮肤恶性黑色素瘤住院患者[男48例,女41例;平均年龄(51.62± 14.35)岁],注射99Tcm-利妥昔单抗后0.5～1.0 h行平面显像.术中据显像结果行SLNB,将切取的SLN行常规HE染色及免疫组织化学检查.随访患者OS和DFS.分析患者临床特征(年龄、性别、原发灶部位、原发灶厚度、原发灶有无溃疡)与SLN显像、SLNB及SLN病理间的关系及其对患者OS及DFS的影响.采用单因素方差分析、两样本t检验、x2检验及Cox回归分析数据.结果 89例患者SLN显像及SLNB成功率均为100％.术前及术中分别检出SLN 207和228枚.病理检测发现转移患者21例,转移淋巴结33枚.5项临床特征中,按不同原发灶部位分组者的术前SLN显像检出SLN数量差异有统计学意义(1.51±1.44、1.38±0.65和2.20± 1.79;F=3.660,P＜0.05);按不同原发灶部位及原发灶有无溃疡分组者的术中SLN探测数量差异有统计学意义(2.85± 1.74、1.54±0.78和1.20± 1.10,2.59± 1.96和2.54±1.46;F=5.504,t=2.588,均P＜0.05);按不同原发灶厚度分组者发生SLN转移比例差异有统计学意义(x2=18.544,P＜0.05).中位随访时间31个月,患者总生存率为95.51％(85/89),总无病生存率为77.53％ (68/89).Cox单因素分析提示SLN有无转移和原发灶厚度影响DFS,但Cox多因素分析未发现统计学意义.结论 99Tcm-利妥昔单抗能够有效、可靠地用于恶性黑色素瘤的SLNB,帮助临床分期和判断预后.

Objective To investigate the accuracy and feasibility of 99Tcm-rituximab SLNB in cutaneous malignant melanoma (CMM) and its influence on survival.Methods A total of 89 patients (48 males,41 females,average age (51.62±14.35) years) with CMM underwent SLN planar imaging 0.5-1.0 h after intradermal injection of 99Tcm-rituximab around primary lesions from June 2008 to November 2014.Based on the image,the SLNs were identified by a gamma probe and removed.The resected SLNs were examined pathologically with both HE and immunohistochemical staining.The results of SLN imaging and SLNB were analyzed retrospectively,and their OS and DFS were followed up.The relationship between the results and the clinical characteristics (age,gender,primary tumor site,primary tumor thickness,ulceration)were analyzed and the influence of SLN status (with or without metastasis) on OS and DFS was evaluated.Data were analyzed with one-way analysis of variance,two-sample t test,x2 test and Cox regression.Results The success rate of SLN imaging and biopsy was 100％ (89/89).There were 207 SLNs detected by lymphoscintigraphy and 228 SLNs by operation.Thirty-three metastatic SLN in 21 cases were confirmed by pathology.The numbers of SLN detected by lymphoscintigraphy were statistically significant among groups with different primary tumor sites (1.51±1.44,1.38±0.65,2.20±1.79;F=3.660,P＜0.05).SLN numbers detected by SLNB were statistically significant among groups with different primary tumor sites (2.85±1.74,1.54±0.78,1.20±1.10;F=5.504,P＜0.05) and between groups with or without ulceration (2.59±1.96,2.54±1.46;t=2.588,P＜0.05).SLN metastatic ratios were statistically significant only in patients with different primary tumor thickness (x2 =18.544,P＜0.05).Median follow-up time was 31 months.The rate of OS was 95.51％ (85/89),and the rate of DFS was 77.53％ (68/89).Univariate analysis found that DFS was affected by SLN status (with or without metastasis) and primary tumor thickness,but no statistical significance was found in Cox-regression.Conclusion 99Tcm-rituximab may be a reliable tracer in SLNB and a helpful tool for staging and prognosis of malignant melanoma.