Prognosis of Acral Melanoma: A Series of 281 Patients
Prognosis of Acral Melanoma: A Series of 281 Patients
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DOI：
10.1245/s10434-013-3089-0
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发表时间：
2013-10-01
影响因子：
3.7
通讯作者：
Ariyan, Charlotte E.
中科院分区：
文献类型：
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作者：
Bello, Danielle M.;Chou, Joanne F.;Ariyan, Charlotte E.
肢端黑色素瘤（AM）是一种罕见的恶性肿瘤，生存率低。本研究定义了一个队列的患者，在一个单一的机构治疗，与生存相关的因素，并与非肢端皮肤黑色素瘤（NACM）进行比较。所有的AM患者从1995年至2010年的前瞻性维护数据库中确定。分析AM的临床病理特征与疾病特异性生存率（DSS）的关系。一项分层、分期匹配的生存分析比较了281例肢端和843例四肢NACM患者的结局，共确定了281例AM患者（掌侧170例，甲下111例）。病理分期（p < 0.001）、溃疡（p < 0.001）、Breslow厚度（p < 0.001）和前哨淋巴结阳性（p < 0.001）是与DSS相关的不良预后指标。在阶段匹配分析中，AM的DSS比NACM差（风险比1.8; 95% CI 1.2-2.7; p < 0.01）。AM肿瘤表现出侵袭性的组织病理学特征，与较差的生存结局相关。AM患者的生存率低于肢体NACM，这可能反映了肿瘤生物学的内在改变。这就需要进一步研究肢端黑色素瘤和皮肤黑色素瘤之间的差异。
Acral melanoma (AM) is an unusual malignancy with poor survival. This study defines a cohort of patients, treated at a single institution, and the factors associated with survival and comparison with nonacral cutaneous melanoma (NACM).All patients with AM presenting from 1995 to 2010 were identified from a prospectively maintained database. Analysis of clinicopathologic features of AM associated with disease-specific survival (DSS) was performed. A stratified, stage-matched survival analysis compared the outcome of 281 acral to 843 extremity NACM patients.A total of 281 AM patients (170 volar, 111 subungual) were identified. Pathologic stage (p < 0.001), ulceration (p < 0.001), Breslow thickness (p < 0.001), and a positive sentinel lymph node (p < 0.001) were found to be poor prognostic indicators associated with DSS. In stage-matched analysis, AM had a worse DSS compared with NACM (hazard ratio 1.8; 95 % CI 1.2-2.7; p < 0.01).This study represents the largest, single-institution series describing the characteristics and outcomes of AM. AM tumors exhibit aggressive histopathologic features associated with a poorer survival outcome. AM patients have an inferior survival than extremity NACM when matched for stage, perhaps reflecting inherent alterations in tumor biology. This warrants further investigation into the differences between acral and cutaneous melanoma.