完成淋巴结清扫手术（CLND）不再作为黑色素瘤治疗的常规推荐。省略CLND可能会导致某些患者被低估，这类患者的III A期和IIIB-C期之间的区别可能会改变辅助治疗的建议。本研究的目的是确定随着CLND使用量的下降是否发生了分期迁移。 从2012年到2018年，从国家癌症数据库（NCDB）中筛选出临床无淋巴结转移的≥ T1b型皮肤黑素瘤患者。对CLND的利用率和AJCC分期的变化进行分析。对仅接受双核素淋巴结活检（SLNB）和接受SLNB + CLND的患者进行比较。 总体上，有68,933名患者符合纳入标准，其中60,536名接受了SLNB，其中9031例（14.9％）肿瘤呈阳性。在这些患者中，3776例（41.8％）接受了CLND。接受CLND的患者年龄较小（58岁与62岁，p <0.0001），男性比例更高（61.5％与57.9％，p = 0.0005）。如果接受SLNB + CLND，则患者的N分类 > N1a的概率更高（36.8％与19.3％，p <0.0001）。这在两组 IIIA期患者之间产生了轻微的差异（SLNB alone 34.0％，SLNB + CLND 31.8％，p <0.0001）。对于T1b / T2a肿瘤的患者来说，如果他们有额外阳性淋巴结，他们将从IIIA期升至IIIC期，SLNB + CLND后的IIIC发生率只比仅接受SLNB略高（4.4％与1.1％，p <0.0001）。 CLND的利用率在过去7年里从2012年的59％降至2018年的12.6％，p <0.0001。但是，在整个研究期间，所有患者的IIIA期疾病发病率仍然保持稳定。 虽然在过去7年中，SLNB阳性后进行CLND的利用率急剧下降，但可能对辅助治疗决策产生影响的分期迁移并未发生到临床意义上的程度。 © 2023年，外科肿瘤学会。

Completion lymph node dissection (CLND) is no longer recommended routinely in the treatment of melanoma. CLND omission may understage patients for whom the distinction between stage IIIA and IIIB-C could alter adjuvant therapy recommendations. The aim of this study is to determine if stage migration has occurred with the declining use of CLND.Patients with clinically node-negative ≥ T1b cutaneous melanoma were identified from the National Cancer Database (NCDB) from 2012 to 2018. CLND utilization and changes in AJCC staging were analyzed. Patients undergoing sentinel lymph node biopsy (SLNB) alone were compared with those undergoing SLNB + CLND.Overall, 68,933 patients met inclusion criteria and 60,536 underwent SLNB, of which 9031 (14.9%) were tumor positive. CLND was performed in 3776 (41.8%). Patients undergoing CLND were younger (58 versus 62 years, p < 0.0001) and more likely male (61.5% versus 57.9%, p = 0.0005). Patients were more likely to have an N classification >N1a if they received SLNB + CLND (36.8%) versus SLNB alone (19.3%), p < 0.0001. This translated to a small difference in stage IIIA patients between groups (SLNB alone 34.0%, SLNB + CLND 31.8%, p < 0.0001). Of the patients with T1b/T2a tumors who would be upstaged from IIIA to IIIC with identification of additional positive nodes, IIIC incidence was only slightly higher after SLNB + CLND compared with SLNB alone (4.4% versus 1.1%, p < 0.0001). CLND utilization dramatically decreased from 59% in 2012 to 12.6% in 2018, p < 0.0001. However, the incidence of stage IIIA disease for all patients remained stable over the 7-year study period.While the utilization of CLND after positive SLNB has declined dramatically in the last 7 years, stage migration that may affect adjuvant therapy decisions has not occurred to a clinically meaningful degree.© 2023. Society of Surgical Oncology.