Malignant melanoma arising during pregnancy. A study of 100 patients.
Malignant melanoma arising during pregnancy. A study of 100 patients.
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怀孕期间出现的恶性黑色素瘤。
DOI：
10.1097/00000658-199005000-00005
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发表时间：
1990
影响因子：
9
通讯作者：
Seigler,HF
中科院分区：
文献类型：
--
作者：
SlingluffJr,CL;Reintgen,DS;Vollmer,RT;Seigler,HF
黑色素瘤通常在年轻人中诊断出来，其中很大一部分是育龄妇女。妊娠期间诊断为黑色素瘤的妇女的预后仍有争议。已经确定了100名年龄在19至40岁之间的患者，他们在诊断黑素瘤时怀孕。所有患者均行局部切除术。16%的患者接受了选择性淋巴结清扫术。83%的患者接受了免疫治疗。自诊断之日起平均随访6.8年。将这些患者与年龄匹配的86名诊断时未怀孕的女性进行比较。在随访期间，妊娠组的总死亡率为25%，对照组为23%。在妊娠组中，随访期间淋巴结转移的发生率增加（39%对26%，p = 0.053）。在I期患者中，妊娠组的DFI显著较短（p = 0.039），50%的妊娠患者和67%的对照患者在10年时无疾病。同样，在1期患者中，妊娠组发生淋巴结转移的时间较短（p = 0.021）。多变量分析表明，当控制肿瘤部位、厚度和Clark水平时，诊断时妊娠与转移性疾病的发展显著相关（p = 0.008）。然而，在怀孕期间发生黑色素瘤的患者的生存率并没有显著降低。
Melanoma is often diagnosed in young adults, a significant proportion of whom are women of child-bearing age. The prognosis of women diagnosed with melanoma during a pregnancy continues to be debated. One hundred patients, ages 19 to 40 years, have been identified who were pregnant at the time of diagnosis of their melanoma. All were treated with local excision. Sixteen per cent underwent elective lymph node dissections. Immunotherapy was administered to 83% of patients. Mean follow-up was 6.8 years from the date of diagnosis. The patients were compared to an age-matched group of 86 women who were not pregnant at the time of diagnosis. Overall mortality during the follow-up period was 25% in the pregnant group and 23% in the control group. Among the pregnant group, there was an increased incidence of lymph node metastases during the follow-up period (39% versus 26%, p = 0.053). Among stage I patients, there was a significantly shorter DFI for the pregnant group (p = 0.039), with 50% of pregnant patients and 67% of control patients free of disease at 10 years. Similarly, among stage 1 patients, the time to development of lymph node metastases was shorter in the pregnant group (p = 0.021). Multivariate analysis demonstrated that pregnancy at diagnosis was significantly associated with the development of metastatic disease (p = 0.008), when controlling for tumor site, thickness, and Clark level. Patients who developed melanoma during pregnancy did not, however, have a significant decrease in survival.