MODEL PREDICTING SURVIVAL IN STAGE-I MELANOMA BASED ON TUMOR PROGRESSION
MODEL PREDICTING SURVIVAL IN STAGE-I MELANOMA BASED ON TUMOR PROGRESSION
复制标题
DOI：
10.1093/jnci/81.24.1893
复制
发表时间：
1989-12-20
影响因子：
10.3
通讯作者：
HALPERN, AC
中科院分区：
文献类型：
--
作者：
CLARK, WH;ELDER, DE;HALPERN, AC
我们使用肿瘤进展的病变步骤和多变量逻辑回归来开发原发性临床I期皮肤黑色素瘤的预后模型。该模型预测生存率的准确率为89%。使用组织学标准，我们通过确定其特定的生长阶段来分配黑色素瘤的肿瘤进展步骤。这些阶段分别为原位侵袭性径向生长期和垂直生长期（在径向生长期或无明显径向生长期的真皮生长中出现真皮肿瘤结节或真皮肿瘤斑块的局灶性形成）。在最短随访100.6个月，中位随访150.2个月后，发现122例侵袭性放射生长期肿瘤无转移。264例肿瘤进入垂直生长期的患者8年生存率为71.2%。通过使用多变量logistic回归模型，这些患者的生存预测得到了提高。为了进入这个模型，测试了23个属性。其中6例具有独立预测预后的信息：(a)每平方毫米有丝分裂率，(b)肿瘤浸润淋巴细胞，(c)肿瘤厚度，(d)原发性黑色素瘤的解剖部位，(e)患者性别，(f)组织学退化。当将每平方毫米有丝分裂率、肿瘤浸润淋巴细胞、原发部位、性别和组织学回归添加到仅包含肿瘤厚度的logistic回归模型中时，它们是8年生存率的独立预测因子（P < .0005）。
We used the lesional steps in tumor progression and multivariable logistic regression to develop a prognostic model for primary, clinical stage I cutaneous melanoma. This model is 89% accurate in predicting survival. Using histologic criteria, we assigned melanomas to tumor progression steps by ascertaining their particular growth phase. These phases were the in situ and invasive radial growth phase and the vertical growth phase (the focal formation of a dermal tumor nodule or dermal tumor plaque within the radial growth phase or such dermal growth without an evident radial growth phase). After a minimum follow-up of 100.6 months and a median follow-up of 150.2 months, 122 invasive radial-growth-phase tumors were found to be without metastases. Eight-year survival among the 264 patients whose tumors had entered the vertical growth phase was 71.2%. Survival prediction in these patients was enhanced by the use of a multivariable logistic regression model. Twenty-three attributes were tested for entery into this model. Six had independently predictive prognostic information: (a) mitotic rate per square millimeter, (b) tumor-infiltrating lymphocyes, (c) tumor thickness, (d) anatomic site of primary melanomo, (e) sex of the patient, and (f) histologic regression. When mitotic rate per square millimeter, tumor-infiltrating lymphocytes, primary site, sex, and histologic regression are added to a logistic regression model containing tumor thickness alone, they are independent predictors of 8-year survival (P < .0005).