Metastatic melanoma to lymph nodes in patients with unknown primary sites
Metastatic melanoma to lymph nodes in patients with unknown primary sites
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DOI：
10.1002/cncr.21835
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发表时间：
2006-05-01
期刊：
影响因子：
6.2
通讯作者：
Ross, MI
中科院分区：
文献类型：
--
作者：
Cormier, JN;Xing, Y;Ross, MI
背景。在缺乏已知原发部位（MUP）的情况下，淋巴结转移性黑色素瘤的自然病程尚不清楚；因此，MUP患者的治疗指南尚不明确。作者对 1990 年至 2001 年因黑色素瘤转移至区域淋巴结而接受手术切除的连续黑色素瘤患者进行了回顾性分析。在这些患者中，确定了 71 名 MUP 患者和 466 名对照患者，这些患者具有相似阶段且原发部位已知的区域淋巴结转移。使用 Cox 比例风险模型评估临床病理因素与生存之间的关联。结果。接受淋巴结清扫后，MUP 患者被分类为 N1b 疾病（47%）、N2b 疾病（14%）或 N3 疾病（39%）。中位随访时间为 7.7 年，MUP 患者的 5 年和 10 年总生存率分别为 55% 和 44%，而对照组分别为 42% 和 32% (P = .04)。在多变量分析中，年龄 50 岁或以上、男性和 N2b 或 N3 疾病状态被确定为不良预后因素，而 MUP 被确定为总生存期的有利预后因素（风险比，0.61；95% 置信区间，0.42-0.86；P = .006）。结论。当前研究中 MUP 患者相对有利的长期生存表明，MUP 患者的自然病程与许多 III 期疾病患者的生存相似（如果不是更好）。因此，MUP 患者应采用具有治愈目的的积极手术方法进行治疗，并应考虑采用 III 期辅助治疗方案。
BACKGROUND. The natural history of metastatic melanoma in lymph nodes in the absence of a known primary site (MUP) has been defined poorly; thus, treatment guidelines for patients with MUP are not clear-cut.METHODS. The authors conducted a retrospective analysis of consecutive patients with melanoma (from 1990 to 2001) who underwent Surgical resection for melanoma metastatic to regional lymph nodes. Among those patients, 71 patients with MUP and 466 control patients who had regional lymph node metastases of similar stage with a known primary site were identified. Associations between clinicopathologic factors and Survival were estimated by using the Cox proportional hazards model.RESULTS. After they underwent lymph node dissection, patients with MUP were classified with N1b disease (47%), N2b disease (14%), or N3 disease (39%). With a median follow-up of 7.7 years, the 5-year and 10-year overall survival rates were 55% and 44%, respectively, for patients with MUP, compared with 42% and 32%, respectively, for the control group (P = .04). In multivariate analyses, age 50 years or older, male gender, and N2b or N3 disease status were identified as adverse prognostic factors, and MUP was identified as a favorable prognostic factor (hazard ratio, 0.61; 95% confidence interval, 0.42-0.86; P = .006) for overall survival.CONCLUSIONS. The relatively favorable long-term Survival of patients with MUP in the Current study Suggested that patients with MUP have a natural history that is similar to (if not better than) the survival of many patients with Stage III disease. Therefore, patients with MUP should be treated with an aggressive surgical approach with curative intent and should be considered for Stage III adjuvant therapy protocols.