Selective sentinel lymph node (SLN) dissection is widely used in the management of cutaneous melanoma patients without clinical evidence of nodal metastases. A series of 274 consecutive melanoma patients who underwent melanoma primary excision and SLN mapping at our institutions since 1998, and were thereafter followed up and eventually treated, is reported in this prospective study. The aim was to analyse the parameters associated with a higher risk of occult nodal metastases, to evaluate the clinical outcome of melanoma patients who underwent SLN procedure, and to identify by means of multivariate analysis the prognostic parameters with independent predictive value on disease-free survival (DFS) in node-positive and negative patients. The SLN was tumour-negative in 228 patients (83.2%). A disease progression occurred in 25 (10.9%); among them, 10 patients in whom the initially identified SLN had been negative, developed a clinically and histologically evident positive lymph node in the same basin during follow-up. Five-year DFS and overall survival were 75% and 82%, respectively. In 46 patients (16.8%), the SLN proved to be tumour positive. The percentage of SLN-positive patients varied according to the primary thickness, from 11.8% in patients with Breslow of 2 mm or lower, to 34.7% in patients with Breslow from 2 to 4 mm, up to 55.9% in patients with Breslow greater than 4 mm (P<0.001). Only two patients with Breslow thickness lower than 1 mm had positive SLN biopsy. Five-year DFS and overall survival (OS) were 42 and 69%, respectively, significantly lower than those of negative SLN-patients (P<0.001). Multivariate analyses showed that the parameters with prognostic independent value on DFS were SLN status (micrometastases or macrometastases; P=0.0001), and to a lesser extent, Breslow thickness (P=0.04). In conclusion, our data support the clinical usefulness of SLN dissection as a reliable and accurate staging method in patients with cutaneous melanoma. SLN-positive patient OS (5-year survival 69%) seems to be superior to that historically reported for stage III patients treated with curative nodal dissection only after the clinical evidence of palpable adenopathies (5-year survival 36%). The prognostic relevance of the pattern of SLN invasion (micrometastases/macrometastases) could be the basis for the planning of adjuvant treatment trials on selected groups of patients.
Tomando como punto de partida las peculiaridades que caracterizan el castellano amazónico peruano en sus diversas variedades, este trabajo se propone un análisis dialectológico de la novela Paiche, del escritor y pintor César Calvo de Araújo. En primer término, se examinan las estrategias empleadas por el autor para condensar y reproducir en la obra las principales marcas del sistema fonológico, y, en segundo término, se analiza la dimensión morfosintáctica, dedicando especial atención a los aspectos relacionados con los posesivos y la discordancia nominal.
Este artículo analiza un grupo de imágenes y testimonios recopilados en el Nuevo coronavirus y buen gobierno. Memorias de la pandemia de COVID-19 en Perú del artista y antropólogo ayacuchano Edilberto Jiménez a partir de tres ejes: las representaciones del virus en el imaginario popular, las violencias subjetiva y objetiva del virus plasmadas en los dibujos y la construcción de agencia de la sociedad civil frente a estas violencias. Sostenemos que este libro encarna una justicia restaurativa a la vez que un testimonio polifónico de cómo la pandemia visibilizó y acentuó las diferencias como desigualdades en los ciudadanos más vulnerables: mujeres, niños, ancianos de las familias más humildes de San Juan de Lurigancho, uno de los distritos con pobreza extrema más alta de Lima. En esta línea, subrayamos que la función político-testimonial del libro apunta a la creación de una memoria sobre la crisis sanitaria. Con todo esto, concluimos que este libro es un aporte necesario para reentender los efectos de la pandemia en las zonas de extrema pobreza del Perú, para reflexionar sobre el rol de las imágenes y para construir una memoria en la que los protagonistas sean los más afectados.
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