Prognostic value of ulceration varies across Breslow thicknesses and clinical stages in acral melanoma: a retrospective study.
Prognostic value of ulceration varies across Breslow thicknesses and clinical stages in acral melanoma: a retrospective study.
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DOI：
10.1111/bjd.21026
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发表时间：
2022-06
影响因子：
10.3
通讯作者：
Si, Lu
中科院分区：
文献类型：
--
作者：
Wei, Xiaoting;Wu, Di;Chen, Yu;Li, Hang;Zhang, Rui;Yao, Hong;Chi, Zhihong;Cui, Chuanliang;Bai, Xue;Mao, Lili;Qi, Zhonghui;Li, Ke;Lan, Shijie;Chen, Lizhu;Guo, Rui;Yao, Xinyu;Lian, Bin;Kong, Yan;Dai, Jie;Tang, Bixia;Wang, Xuan;Guo, Jun;Si, Lu
溃疡被认为是一个不利的预后因素，并与肿瘤厚度一起被用来对皮肤黑色素瘤患者进行分类。然而，肢端黑色素瘤(AM)的溃疡对预后的影响是有争议的。评估AM中溃疡的预后影响以及不同Breslow厚度和临床分期的变异性。一项对2000年1月至2017年12月期间诊断为AM的患者进行的多中心回顾性研究。使用多变量COX比例风险模型和LOG-RANK检验评估有溃疡和无溃疡的患者之间黑色素瘤特异性生存(MSS)的差异。在1053名入选患者中，62.6%的患者有溃疡。中位随访61个月后，有溃疡的患者的中位MSS低于无溃疡的患者：66.1月，95%可信区间(CI)60.0~86.0vs未达；危险比1.41，95%CI1.09~1.82；P = 0.012。在患有较薄(≤1 mm)黑色素瘤的患者中，随着时间的推移，有溃疡和无溃疡的患者的生存曲线明显分开(P <； 0.001)。对于厚度为 >； 1 mm的黑色素瘤(T2、T3和T4亚组，所有P值均为0.05)或III期疾病患者(危险比1.09，95%可信区间0.71-1.68，P = 0.39)，未观察到溃疡与MSS之间的关联。溃疡是AM患者的一个独立的负面预后因素，但其影响因Breslow厚度和临床分期而异。溃疡对薄(≤1 mm)黑色素瘤患者的预后有显著影响，但在中/厚AM或III期AM中，溃疡与生存无关根据美国癌症黑色素瘤联合委员会的分期系统，溃疡状况与布雷斯洛肿瘤厚度一起用于将患者细分为不同的阶段。肢端黑色素瘤(AM)是皮肤黑色素瘤的一种独特亚型，其特点是诊断延迟、预后和遗传特征阴性的发生率高，预后差。AM的溃疡对预后的影响仍然存在争议。关于这个话题，我们已经知道了什么？这是第一项评估AM患者溃疡的预后和分期价值的大规模研究。溃疡对薄(≤1 mm)黑色素瘤患者的预后有显著影响，但在中/厚或III期AM患者中，溃疡与生存之间没有相关性。在使用基于溃疡的分期系统时，应考虑这些发现。这项研究增加了什么？链接评论：C.Carrera和S.PodlipnikBR J皮马托尔2022；186：923-924。网上提供通俗易懂的摘要
Ulceration is regarded as an adverse prognostic factor and is used together with tumour thickness to subcategorize patients with cutaneous melanoma. However, the prognostic impact of ulceration in acral melanoma (AM) is controversial. To assess the prognostic impact of ulceration in AM and the variability across different Breslow thicknesses and clinical stages. A multicentre retrospective study of patients diagnosed with AM between January 2000 and December 2017. Differences in melanoma‐specific survival (MSS) between patients with and without ulceration were assessed using the multivariable Cox proportional hazards model and log‐rank test. Among 1053 enrolled patients, 62.6% had ulceration. After a median follow‐up of 61 months, patients with ulceration had a lower median MSS than those without: 66.1 months, 95% confidence interval (CI) 60.0–86.0 vs. not reached; hazard ratio 1.41, 95% CI 1.09–1.82; P = 0.012. Among patients with thin (≤ 1 mm) melanoma, the survival curves of patients with vs. without ulceration clearly separated over time (P < 0.001). No association between ulceration and MSS was observed for melanomas of thickness > 1 mm (subgroups of T2, T3 and T4; all P‐values > 0.05) or patients with stage III disease (hazard ratio 1.09, 95% CI 0.71–1.68, P = 0.39). Ulceration is an independent negative prognostic factor for patients with AM, but the impact varies across Breslow thicknesses and clinical stages. Ulceration has a significant effect on prognosis for patients with thin (≤ 1 mm) melanoma, but there was no association between ulceration and survival in intermediate/thick AM or stage III AM. Ulceration status is used together with Breslow tumour thickness to subcategorize patients into different stages according to the America Joint Committee on Cancer melanoma staging system. As one distinctive subtype of cutaneous melanoma, acral melanoma (AM) is characterized by poor survival outcomes due to delayed diagnosis and a high prevalence of negative prognostic and genetic features. The prognostic impact of ulceration in AM is still controversial. What is already known about this topic? This was the first large‐scale study to assess the prognostic and staging values of ulceration in patients with AM. Ulceration has a significant effect on prognosis for patients with thin (≤1 mm) melanoma, but no association between ulceration and survival was found in intermediate/thick or stage III AM. These findings should be considered when using ulceration‐based staging systems. What does this study add? Linked Comment: C. Carrera and S. Podlipnik. Br J Dermatol 2022; 186:923–924. Plain language summary available online
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影响因子：
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作者：
Bradford, Porcia T.;Goldstein, Alisa M.;McMaster, Mary L.;Tucker, Margaret A.
通讯作者：
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影响因子：
2.3
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Martinez-Said, Hector
影响因子：
10.3
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