Surgical treatment of metastatic melanoma
Surgical treatment of metastatic melanoma
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DOI：
10.1016/s0002-9610(98)00041-5
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发表时间：
1998-05-01
影响因子：
3
通讯作者：
Wilmarth, TJ
中科院分区：
文献类型：
--
作者：
Fletcher, WS;Pommier, RF;Wilmarth, TJ
背景：转移性黑色素瘤患者的生存率很低。化疗和免疫治疗的反应率很低，没有真实的改善生存率。我们回顾了手术切除的结果。方法：我们回顾性分析了1979年至1994年所有接受黑色素瘤转移切除术的患者的病历。转移瘤切除自软组织（n = 28）、腹腔脏器（n = 22）、肺（n = 15）和脑（n = 12）。44例患者完全切除，33例不完全切除。单发病灶切除65例，多发病灶切除12例，5年生存率为10%。单发病灶切除5年生存率为12%，多发病灶切除5年生存率为0完全切除组5年生存率为15%，不完全切除组为4%（P < 0.001）。孤立性病灶完全切除者5年生存率为18%，同期切除与异时切除者的生存率无差异，性别、原发部位、无病期、转移部位对生存率无影响。我们的结论是，转移性黑色素瘤患者应该接受切除术，以（1）缓解阻塞和繁殖等症状，（2）可完全切除的孤立性病变，（3）可完全切除的连续性病变，和（4）可使肉眼无病的选定病例。手术切除上级转移性黑色素瘤的任何其他可用疗法，（C）1998，Excerpta Medica，Inc.
BACKGROUND: The survival of patients with metastatic melanoma is poor. The response rates for chemotherapy and immunotherapy have been low, with no real improvement in survival, We reviewed the results of surgical resection,METHODS: We performed a retrospective review of the medical records of all patients who underwent resection of metastases from melanoma from 1979 to 1994,RESULTS: There were 77 patients (44 men, 33 women, mean age 51 years). Metastases were resected from soft tissue (n = 28), abdominal viscera (n = 22), lung (n = 15), and brain (n = 12). Forty-four patients had complete resections, and 33 had incomplete resections. Sixty-five patients had solitary lesions and 12 had multiple lesions resected, The overall 5-year survival rate was 10%, Patients with solitary lesions had a 5-year survival rate of 12%, compared with 0% for patients with multiple lesions (P = 0.01), Patients with complete resection had a 5-year survival rate of 15%, compared with 4% for patients with incomplete resection (P < 0.001). Patients with complete resection of solitary lesions had a 5-year survival of 18%, There was no difference in survival between synchronous and metachronous resection, Gender, primary site, disease-free interval, and metastatic site had no impact on survival rates.CONCLUSION: We conclude that patients with metastatic melanoma should be resected for (1) relief of symptoms such as obstruction and breeding, (2) solitary lesions that can be completely resected, (3) serial lesions that can be completely resected, and (4) selected cases that can be rendered macroscopically free of disease. Surgical resection is superior to any other available therapy for metastatic melanoma, (C) 1998 by Excerpta Medica, Inc.