免疫治疗使用检查点阻断和BRAF / MEK治疗已经改善了不可切除的黑色素瘤转移患者的总体生存（OS）。在这项回顾性研究中，我们旨在证明切除原发性黑色素瘤（≥1mm厚）和前哨淋巴结（SN）生物检查（SNB）后的黑色素瘤特异性生存（MSS）和OS的增加。使用Kaplan-Meier估计和Cox模型，我们比较了两个连续的队列。队列1（N = 518）的患者在1998年至2009年间进行SNB，而队列2（N = 460）的患者在2010年至2017年间进行了SNB，当时检查点阻断和BRAF /（MEK）抑制剂用于不可切除的复发治疗。两个队列的中位随访时间分别是120个月和73个月。虽然复发无病生存率和远处转移无病生存率保持相似，但MSS和OS有利于队列2。 SN阳性患者的5年OS率估计增加了14.3％（78.5％vs 64.2％，logrank测试：P = 0.005）。即使在SN肿瘤负荷低（转移直径<1mm）的情况下，MSS的受益也是显著的。在多元分析中，有利于第2队列的风险减低在总人口和SN阴性和SN阳性亚组中均显著。在SN阳性患者中，除了现代治疗的可用性外，SN转移对MSS和OS也是独立的因素。使用现代药物治疗不可切除的黑色素瘤复发可在接受SNB的人群中导致显著更高的生存率。从原发性黑色素瘤测量的生存益处影响SN阳性和SN阴性亚群体。该文章受版权保护。版权所有。

Immunotherapies using checkpoint blockade and BRAF/MEK therapies have improved overall survival (OS) in patients with unresectable melanoma metastases. In this retrospective study, we aimed to demonstrate the resulting increase in melanoma-specific survival (MSS) and OS after the excision of primary melanomas (≥1 mm thick) and sentinel lymph node (SN) biopsy (SNB). Using Kaplan - Meier estimates and Cox models, we compared two consecutive cohorts. Patients in cohort 1 (N = 518) underwent SNB between 1998 and 2009, and patients in cohort 2 (N = 460) between 2010 and 2017, when checkpoint blockade and BRAF/ (MEK) inhibition became available for the treatment of unresectable relapses. The median follow-up times were 120 months and 73 months, respectively. While recurrence-free and distant metastasis-free survival rates remained very similar, MSS and OS increased in favor of cohort 2. The estimated 5-year OS rate of SN-positive patients increased by 14.3% (78.5% vs 64.2%, logrank test: P=0.005). The MSS benefit was significant even with low SN tumor burden (metastasis diameter <1 mm). On multivariate analyses, the risk-reduction in favor of cohort 2 was significant in the total population and in the SN-negative and SN-positive subgroups. In SN-positive patients, besides the availability of modern therapies, SN metastasis diameter, and ulceration were independent factors of MSS and OS. Treatment of unresectable melanoma recurrences with modern drug therapies results in significantly higher survival rates in a population with SNB. The survival benefit measured from primary melanoma affects both the SN-positive and SN-negative subpopulations. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.