The Role of Age in Sentinel Lymph Node Radioactivity and Metastasis in Melanoma 公开

Chu, K. Carrie (2010)

Permanent URL: https://etd.library.emory.edu/concern/etds/6w924c52x?locale=zh
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Abstract


ABSTRACT

The Role of Age in Sentinel Lymph Node Radioactivity and Metastasis in Melanoma
By Carrie Kai-Cheng Chu
Background: Elderly patients have less favorable melanoma-specific survival in
comparison to the young, despite reduced risk of nodal metastasis. Age-dependent
decline in lymphatic function is a postulated explanation.
Hypothesis: Lymphatic function and odds of sentinel lymph node (SLN) metastasis are
statistically reduced in melanoma patients with older age compared to their younger
counterparts, controlling for other patient, disease, and technical variables.
Study Design: For this cross-sectional study, a prospectively-maintained institutional
melanoma database was queried for cases of lymphoscintigraphic mapping and SLN
biopsy from 1994-2008. Data regarding highest ex-vivo SLN radioactivity as measured
during biopsy were gathered and analyzed as a measure of lymphatic function.
Associations of age with SLN radioactivity and metastases were assessed using linear and
logistic regression.
Results: Radioactivity counts were available in 1349 patients. Age correlated negatively
with radioactivity count (r= -0.164, p<0.001). Head/neck primaries and cervical SLN
were associated with reduced counts, while ulceration, increased radiocolloid dose, and
increased SLN number were associated with elevated counts. On multivariate analysis,
increasing age was the strongest independent predictor of reduced radioactivity (β= -
109.9, p<0.001). Colloid dose (β= +2.3, p=0.02), SLN number (β= +622.9, p<0.001),
ulceration (β= +1596.7, p=0.02), and cervical SLN (β= -2265.2, p=0.01) also maintained
independent association with count variability. SLN metastasis was detected in 17.9% of
all patients. Prevalence of SLN disease declined with increasing patient age (p=0.02).
On multivariate analysis, increasing age (odds ratio 0.98, 95% confidence interval [0.97-
0.99], p<0.001) and head/neck primary site (odds ratio 0.57, [0.34-0.57], p=0.03) were
negative predictors of SLN disease.
Conclusions: Increasing age is an independent predictor of declining lymphatic function
as measured by SLN radioactivity counts, paralleling an age-related reduction in odds of
SLN metastasis. Age-related lymphatic dysfunction is a potential explanation for the
paradoxical increase in mortality despite reduction in SLN disease in elderly patients with
melanoma.



Table of Contents

Introduction………………………………………………………………………1

Background………………………………………………………………………3

Methods…………………………………………………………………………..8


Results…………………………………………………………………………....15

Discussion………………………………………………………………………...18

References………………………………………………………………………..23

Tables……………………………………………………………………………..28

Table 1. Overall characteristics of study population……………………..28

Table 2. Trends in clinicopathologic variables across age categories……29

Table 3. Determinants of nodal radioactivity…………………………….30

Table 4. Comparison of sentinel node positive and negative patients...….31

Table 5. Determinants of nodal metastasis………………………………..32

Figure……………………………………………………………………………..33

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