An Evidence-Based Staging System for Mucosal Melanoma: A Proposal
An Evidence-Based Staging System for Mucosal Melanoma: A Proposal
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DOI：
10.1245/s10434-022-11670-6
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发表时间：
2022-04-09
影响因子：
3.7
通讯作者：
Guo, Jun
中科院分区：
文献类型：
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作者：
Cui, ChuanLiang;Lian, Bin;Guo, Jun
背景粘膜黑色素瘤（MuM）没有一个广泛应用的涵盖所有解剖部位的分期系统。我们假设来自不同解剖部位的MuM患者可以使用共同的方法进行分期。方法采用前瞻性数据库，纳入1814例MuM患者，中位随访5.14年。总生存期（OS）从病理诊断时间计算至任何原因死亡日期。采用Cox比例风险模型对预后变量和OS进行多因素分析。结果对于局限性MuM，最显著的中位OS差异是原发肿瘤侵袭粘膜下层（即T1）与更深（即T2/T3/T4）：分别为4.3年、3.4年、3.1年和2.9年（p < 0.001）。对于仅出现区域淋巴结转移的患者，最显著的是：1 vs >= 2区域淋巴结（N1 vs N2, 2.5 vs 2.1年，p < 0.001）。对于出现远处转移的患者，皮肤/皮下组织/远处淋巴结（M1a）、肺转移（M1b）、除脑（M1c）和脑（M1d）外的所有其他内脏部位的中位OS分别为1.5、1.2、0.8和0.6年（p < 0.001）。基于这些结果，提出了MuM的分期系统：(1)I期：T1N0M0（中位生存期，4.3年）；(2) II期：T2-4N0M0（3.1年）；(3) IIIA期：T1-4N1M0（2.5年），IIIB期：T1-4N2M0（2.1年）；(4) IV期：T(any)N(any)M1（0.9年）（p < 0.001）。结论粘膜黑色素瘤的单一、统一的分期系统包括所有解剖原发肿瘤部位，可以协调MuM的分期和临床试验的设计。
Background There is no widely employed staging system for mucosal melanoma (MuM) that incorporates all anatomic sites. We hypothesized that MuM patients arising from different anatomical sites could be staged using a common approach. Methods A prospective database contained 1814 MuM patients with a median follow-up of 5.14 years was employed. Overall survival (OS) was calculated from the time of pathological diagnosis to the date of death from any cause. Multivariate analyses of prognostic variables and OS were performed using the Cox proportional hazard model. Results For localized MuM, the most significant median OS differences were primary tumors invading submucosa (i.e., T1) versus deeper (i.e., T2/T3/T4): 4.3 versus 3.4, 3.1, and 2.9 years, respectively (p < 0.001). For patients only with regional node metastasis at presentation, the most significant were: 1 versus >= 2 regional nodes (N1 vs. N2, 2.5 vs. 2.1 years, p < 0.001). For patients with distant metastasis at presentation, the median OS was 1.5, 1.2, 0.8, and 0.6 years respectively for skin/subcutaneous tissue/distant lymph nodes (M1a), lung metastasis (M1b), all other visceral sites except brain (M1c), and brain (M1d) (p < 0.001). Based on these results, the staging system for MuM is proposed: (1) Stage I: T1N0M0 (median OS, 4.3 years); (2) Stage II: T2-4N0M0 (3.1 years); (3) Stage IIIA: T1-4N1M0 (2.5 years), Stage IIIB: T1-4N2M0 (2.1 years); (4) Stage IV: T(any)N(any)M1 (0.9 years) (p < 0.001). Conclusions A single, unified, staging system for mucosal melanoma inclusive of all anatomical primary tumor sites can harmonize staging of MuM and the design of clinical trials.