Uporabna vrijednost sadašnjih kriterija u određivanju indikacije za biopsiju limfnog čvora čuvara u bolesnika s primarnim melanomom kože

doctoral thesis

• Title (english): Values of the current criteria in determining the indications for the sentinel lymph node biopsy among the patients with primary skin melanoma
• Author: Damir Homolak; VIAF: 305732068
• Mentor: Mirna Šitum (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2015-03-27, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

U nastojanju da smanjimo broj nepotrebnih SLNB i usmjerimo primjenu ove procedure prema
rizičnijim skupinama bolesnika, testirali smo hipotezu da debljina tumora nije dostatan
čimbenik pri postavljanju indikacije. Analizirali smo uporabnu vrijednost svih dostupnih
kliničkih i patohistoloških parametara u bolesnika sa primarnim kutanim melanomom.
U istraživanju je korištena arhiva RC za melanom MiZRH u Klinici za kožne i spolne bolesti i
Zavoda za patologiju "Ljudevit Jurak", KBC "Sestre milosrdnice". Studijom su obuhvaćena
844 bolesnika, u promatranom razdoblju od 6 godina. Sentinel biopsija učinjena je kod 484
bolesnika (57%), od kojih je pozitivan čvor zabilježen u 122 slučaja (14,45%). Kod 205
(24,28%) bolesnika došlo je do progresije bolesti. Polovica naših bolesnika imala je tanke
tumore (<1,5 mm). Posebno smo analizirali ovu skupinu bolesnika, stratificirajući tumore u
rastući niz za po 0,25 mm. Kod 184 bolesnika (43%), učinjena je sentinel biopsija, sa
pozitivnim ishodom kod 22 bolesnika (12%). U 30 bolesnika (7,65%) došlo je do razvoja
metastatske bolesti. Unutar ove skupine čak 50% pozitivnih čvorova nađeno u grupi tumora
tanjih od 1 mm, što ukazuje na agresivnost nekih tankih lezija.
Logističkom regresijom testirali smo povezanost zavisnih varijabli (sentinel nalaz i prisutnost
metastaza) s nezavisnim varijablama (klinički i patohistološki parametri). Standardiziranim
omjerima šansi koji su učinjeni za dob i spol, debljinu, te prisustvo mitoza i ulceracija,
dobiveni su rezultati koji upućuju na bitno različit biološki potencijal tankih tumora.
Stupnjevitom logističkom regresijom postavljeni su matematički modeli za predviđanje
ishoda sentinel biopsije i razvoja metastatske bolesti s točnostima predviđanja od 80%.
Uzevši u obzir sadašnju točnost kliničke prosudbe (oko 20%) te da nisu uključeni nikakvi
novi parametri u model, primjena ovih modela kao dodatnog alata u dvojbenim kliničkim
situacijama apsolutno znači prednost, a u bolničkim centrima gdje ne postoji
dermatoonkologija važan doprinos u boljem probiru bolesnika za SLNB.
U proučavanju ishoda metastatske bolesti uočili smo i određena grupiranja bolesnika vezana
za dob i spol, a moguće i hormonalni status bolesnica.
Istraživanje je potvrdilo hipotezu da debljina nije dostatan čimbenik prilikom postavljanja
indikacije za SLNB, pa je čak nebitan parametar u predikciji metastatskog ishoda kod tankih
tumora. Kombinacijom trenutno dostupnih kliničko-patohistoloških parametara postiže se
bolja predikcija ishoda sentinela i metastaza.

Abstract (english)

The aim of the study was to determine which clinico-pathohistological parameters represent
high risk factors for metastatic progression which would enable better selection of SLNB
candidates.
Study group included 844 patients with PCM diagnosed between January 1, 2005 and
December 31, 2010. SLNB was conducted in 484 (57.3%) patients. Positive node has been
found in 122 (14.5%) and metastatic development in 205 (24.28%) patients.
Half of our patients had thin tumors (≤1.5 mm). This group was stratified by 0.25 mm and
tested separately. 184 (43%) patients underwent SLNB, with positive results in 22 patients
(12%). Metastatic development was found in 30 patients (7.65%).
Multivariate analysis was done on both group, testing SLNB and metastatic outcome.
When deciding to conduct SLNB, except tumor thickness, other parameters must be taken
into consideration, among which: ulceration, lymphocyte infiltration, microsatellitosis, Clark
level, trunk and acral localization and male gender predict a positive SLNB outcome. It seems
that additional presence of mitoses and nodular melanoma increase the probability of
metastatic spread. In the group of thin lesions: gender, localization and type of melanoma
does not play an important role.
Further analysis with different cofounding variables: age, gender, thickness, mitotic rate and
ulceration gave us quite different results, showing significantly different biological behavior
of thin tumors.
By applying stepwise logistic regression we set up mathematical models for prognosis of
sentinel and metastatic outcome. With accuracy approximately 80%, this could be good
additional tool in risk estimation.
Particularly in case of very thin lesions, tumor thickness is not sufficient and should be
evaluated with other clinico-pathohistological indicators.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:988790
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 134 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 07:30:31