近期对进行有指示淋巴结活检（SLNB+）的患者的研究显示，进行淋巴结盆腔监测与完全淋巴结清扫（CLND）的患者在黑色素瘤特异性存活方面没有差异。尽管如此，这种方法被广泛应用，但头颈部皮肤黑色素瘤患者的数量较少。为了考察这一结果在头颈部黑色素瘤队列中是否适用，我们从2012年至2019年选择了有SLNB+的头颈部黑色素瘤患者，并从国家癌症数据库（NCDB）中获取数据。比较了只接受SLNB和接受SLNB+CLND的患者的总体生存率（OS）。根据病理N（pN）和免疫疗法的接受情况进行亚组分析，并计算调整风险比（aHR）和95%置信区间（CI）。 通过对634名患者进行多因素Cox回归分析，发现在只接受SLNB和接受SLNB+CLND的队列中，OS没有差异（风险比[HR] 1.13；95%置信区间[CI] 0.71-1.81；p=0.610）。同时，Charlson-Deyo评分（CDS）1与0相比（HR 1.70；95% CI 1.10-2.63；p=0.016）、pN2+与pN1相比（HR 1.74；95% CI 1.23-2.45；p=0.002）以及淋巴管血管侵犯（LVI）与无（HR 2.07；95% CI 1.34-3.19；p=0.001）都与预后较差相关。根据pN进行的亚组分析显示，无论是pN1患者（HR 1.04；95% CI 0.51-2.10；p=0.922）、pN2+患者（HR 1.31；95% CI 0.67-2.57；p=0.427）还是接受免疫疗法的患者（HR 1.32；95% CI 0.54-3.22；p=0.549），都没有CLND在OS方面的益处。 本研究表明，在进行SLNB的头颈部黑色素瘤患者中，只接受SLNB与接受SLNB+CLND在OS方面没有差异。需要进一步的研究来更好地定义CLND的作用角色。© 2023. 外科肿瘤学会。

Recent studies evaluating patients with a positive sentinel lymph node biopsy (SLNB+) show no melanoma-specific survival difference between patients undergoing lymph node basin surveillance and completion lymph node dissection (CLND). This has been broadly applied, despite underrepresentation of head and neck (HN) cutaneous melanoma patients. We evaluated whether this was upheld in the HN melanoma cohort.Patients with HN melanoma with a SLNB+ were selected from the National Cancer Database (NCDB) from 2012 to 2019. Overall survival (OS) of patients who underwent SLNB only versus SLNB + CLND were compared. Subgroup analyses were performed based on pathologic N (pN) and receipt of immunotherapy. Adjusted hazard ratio (aHR) and 95% confidence interval (CI) were calculated.Analysis of 634 patients with multivariable Cox regression showed no difference in OS in SLNB only versus SLNB + CLND cohorts (hazard ratio [HR] 1.13; 95% confidence interval [CI] 0.71-1.81; p = 0.610). Charlson-Deyo score (CDS) 1 versus 0 (HR 1.70; 95% CI 1.10-2.63; p = 0.016), pN2+ versus pN1 (HR 1.74; 95% CI 1.23-2.45; p = 0.002), and lymphovascular invasion (LVI) versus no (HR 2.07; 95% CI 1.34-3.19; p = 0.001) were associated with worse prognosis. Subgroup analysis by pN showed no OS benefit for CLND in either pN1 (HR 1.04; 95% CI 0.51-2.10; p = 0.922) or pN2+ (HR 1.31; 95% CI 0.67-2.57; p = 0.427) patients or in patients who received immunotherapy (HR 1.32; 95% CI 0.54-3.22; p = 0.549).This study of SLNB + HN melanoma patients showed no OS difference in SLNB only versus SLNB + CLND. Further studies need to be performed to better define the role of CLND.© 2023. Society of Surgical Oncology.