Assessment of survival benefit from sentinel node biopsy for melanoma: a systematic review and meta-analysis.

Methods

This systematic reviewand meta-analysisinvolved searches of Medline, Embase, Cochrane CENTRAL, and ClinicalTrials.gov (up to Jan 8, 2025) using terms for melanoma, SNB, and survival. Studies were included if they reported survival in adults (ie, aged ≥18 years) with melanoma who underwent SNB relative to those who did not, and excluded studies without these data, because survival risk in people with melanoma could not be calculated.

本系统评价和荟萃分析通过检索Medline、Embase、Cochrane CENTRAL和ClinicalTrials.gov（截至2025年1月8日）进行，使用了关于黑色素瘤、SNB和生存的术语。如果研究报道了接受SNB的成年黑色素瘤患者（即年龄≥18岁）相对于未接受SNB的患者的生存情况，并排除了没有这些数据的研究，因为无法计算患有黑色素瘤人群的生存风险，那么这些研究将被纳入分析。

Duplicate title review (by GJW and CAG) and data extraction (by GJW and MBW) were performed.

标题重复性审查（由GJW和CAG执行）和数据提取（由GJW和MBW执行）已完成。

The primary outcome was death from melanoma.

主要结果是黑色素瘤导致的死亡。

Risk of bias was assessed using the Newcastle-Ottawa and Cochrane Collaboration tools.

使用纽卡斯尔-渥太华量表和Cochrane协作工具评估偏倚风险。

This study was registered with PROSPERO (number CRD4203494674).

该研究已在PROSPERO注册（注册号CRD4203494674）。

Results

From 1560 screened records, 60 studies were eligible for analysis.

在筛选的1560条记录中，有60项研究符合分析条件。

After the exclusion of one study with high selection bias meta-analysis, 13 studies (40 287 participants) reporting an adjusted risk were analysed and showed a significantly reduced risk of death from melanoma for people who underwent SNB: hazard ratio(HR) 0·86 (95% CI 0·81-0·92, p<0·0001), with low heterogeneity (I2 16%).

在排除了一项存在高度选择偏倚的元分析研究后，对13项报告调整风险的研究（共40,287名参与者）进行了分析，结果显示接受前哨淋巴结活检（SNB）的黑色素瘤患者死亡风险显著降低：风险比（HR）为0.86（95%置信区间0.81-0.92，p<0.0001），异质性低（I2为16%）。

Sensitivity analyses confirmed that this result was not dependent on any single study or on the use of systemic therapy.

敏感性分析确认了这一结果并不依赖于任何单一研究或全身治疗的使用。

A similar result was obtained from the analysis of the five studies (27 540 participants) that reported 5-year risk of death from melanoma: HR 0·84 (95% CI 0·78-0·90, p<0·0001) with low heterogeneity (I2 15%).

从五项研究（共27,540名参与者）的分析中得到了类似的结果，这些研究报告了黑色素瘤5年死亡风险：风险比（HR）为0.84（95%置信区间0.78-0.90，p<0.0001），异质性较低（I2为15%）。

A 10-year risk of death from melanoma was reported in two studies with three estimates: 0·87 (0·71-1·06; p=0·17) and with greater heterogeneity (I2 41%).

两项研究报告了黑色素瘤10年死亡风险的三个估计值：0·87 (0·71-1·06; p=0·17)，并且存在较大的异质性（I2 41%）。

From nine studies (11 625 participants) reporting an adjusted risk of recurrence, the HR was 0·71 (95% CI 0·66-0·76, p<0·0001) with low heterogeneity (I2 23%).

九项研究报告了调整后的复发风险，风险比为0·71 (95% 置信区间 0·66-0·76, p<0·0001)，并且存在较低的异质性（I2 23%）。

interpretation

This meta-analysisshowed that people with melanoma who underwent SNB had a significantly reduced risk of death from melanoma and recurrence compared with those who did not.

这项荟萃分析显示，接受前哨淋巴结活检（SNB）的黑色素瘤患者与未接受者相比，死于黑色素瘤和复发的风险显著降低。

These findings are consistent with the only published randomised controlled trialand were robust on sensitivity analyses, indicating that SNB confers true survival and recurrence benefits.

这些发现与唯一发表的随机对照试验结果一致，并在敏感性分析中表现稳健，表明前哨淋巴结活检（SNB）确实带来了生存和减少复发的好处。

funding

None.

无。