Estudio de los factores predictivos de afectación metastásica en el ganglio centinela y en los ganglios ''no centinela'' tras infadenectomía en el melanoma

Resum

Over the past decades, lymph node management in MM has changed. Recently, two important studies have been published and conclude that lymphadenectomy does not report a survival benefit in patients with lymph node involvement, compared to observation. It would be interesting, to determine which are the predictive factors of metastatic disease in the '' non-sentinel '' nodes after a positive SLNB. OBJETIVES MAIN OBJETIVES To determine which preoperative factors allow us to predict the probability of metastatic involvement in the “non-sentinel” nodes in patients with positive SLNB. To establish a probability formula to determine the risk of ''non-sentinel'' nodes metastatic disease. To establish the values of these variables that allow us to predict the metastatic involvement in the '' non-sentinel '' lymph nodes of patients with MM. SECONDARY OBJETIVES To investigate the specific characteristics of our study population in relation to the analyzed variables. To determine which preoperative variables allow us to predict the probability of metastatic involvement in the SLN. To establish a probability formula to determine the risk of metastasic disease in the SLN. METHODS This is an observational and retrospective study of patients with Malignant Melanoma, in health areas II and VIII of CARM. These were subjected to surgical treatment; exeresis of the primary tumor and subsequent use of the SLNB technique, between January 2012 and January 2021. Different variables of each patient will be analyzed and the SPSS 22.0 program will be used for statistical analysis. CONCLUSIONS The variables related to metastatic disease in the ''non-sentinel'' nodes after lymphadenectomy in the univariate study are; age, Breslow thickness, Clark level, vascular invasion, and lymphatic invasion. In the multivariate analysis, age, Breslow thickness and Clark level are significant factors with respect to metastatic involvement of the '' non-sentinel '' lymph nodes. The probability formula is developed by which we can determine the risk of each patient. The formula is: p=e^((-20,966+0,132·A+0,515·B+2,524·C))/(1+e^((-20,966+0,132·A+0,515·B+2,524·C)) ) The age at diagnosis from which there is a greater probability of presenting metastatic disease in the '' non-sentinel '' lymph nodes of the lymphadenectomy is 48.5 years, with a p <0.04, a sensitivity of 87,5% and a specificity of 53.8%. A Breslow thickness > 2.90 mm is considered a risk factor for development of metastatic disease, with p <0.05, a sensitivity of 100% and a specificity of 61.5%. From Clark level III, with a p <0.03, the probability of metastasic disease in "non-sentinel" lymph node also increases. The population of this study has similar characteristics to those published in the rest of the series described in the literature. The variables that are related to the presence of metastatic involvement in the SLN in the univariate study are; bleeding, ulceration of the lesion, clinic associated with the tumor, the size of the lesion (PA), the Breslow thickness, the Clark level, the mitotic rate, the presence of BRAF mutation, the diagnosis according to the type of MM, T (TNM) and tumor stage. In the multivariate analysis, the Breslow thickness and T (TNM) are significant factors in metastatic involvement of the SLN. The probability formula is developed by which we can determine the risk of each patient. The formula is: p=e^((-1,351+0,231·A+0,419·B) )/(1+e^((-1,351+0,231·A+0,419·B)