Prognostic implications of anatomic location of primary cutaneous melanoma of 1 mm or thicker
Prognostic implications of anatomic location of primary cutaneous melanoma of 1 mm or thicker
复制标题
DOI：
10.1016/j.amjsurg.2011.06.048
复制
发表时间：
2011-12-01
影响因子：
3
通讯作者：
McMasters, Kelly M.
中科院分区：
文献类型：
--
作者：
Callender, Glenda G.;Egger, Michael E.;McMasters, Kelly M.
背景：乳腺厚度、溃疡和前哨淋巴结（SLN）状态是皮肤黑色素瘤患者最重要的预后因素。与这些因素相比，原发肿瘤的解剖位置通常被认为在决定预后方面起次要作用。本分析是为了更好地确定原发性黑色素瘤的解剖位置对预后的影响。方法：在一项前瞻性随机试验的事后分析中，该试验纳入了年龄在18至70岁之间的brreslow厚度≥1mm的黑色素瘤患者，所有患者都进行了SLN活检，如果发现肿瘤阳性SLN，则进行了完全淋巴结切除术。Kaplan-Meier生存分析、单因素和多因素分析评估无病生存（DFS）、局部和中转无复发生存（LITRFS）和总生存（OS）的预测因素。结果：该分析共纳入2500例患者，中位随访期为68个月。解剖部位包括头、颈、躯干、上肢和下肢。在单变量分析中，年龄、Breslow厚度和SLN阳性患者的百分比因解剖位置而有显著差异，SLN阳性状态、是否存在回归、性别和组织学亚型也有显著差异（P < 0.0001）。在多变量分析中，解剖位置是SLN状态（P < 0.0001）、DFS （P = 0.045）、LITRFS （P = 0.023）和OS （P < 0.0001）的独立预测因子。通过Kaplan-Meier分析，解剖位置与DFS、LITRFS和OS显著相关。结论：原发性黑色素瘤的解剖位置是SLN状态和预后的重要独立预测因素。头颈部和躯干原发性黑色素瘤患者的预后比其他解剖部位的原发性黑色素瘤差。(C) 2011爱思唯尔公司版权所有。
BACKGROUND: Breslow thickness, ulceration, and sentinel lymph node (SLN) status are well established as the most important prognostic factors for patients with cutaneous melanoma. Anatomic location of the primary tumor is generally considered to play a minor role in determining prognosis compared with these other factors. This analysis was performed to better define the influence of anatomic location of the primary melanoma on prognosis.METHODS: In this post hoc analysis of a prospective randomized trial that included patients ages 18 to 70 years with melanomas 1 mm or greater in Breslow thickness, all patients underwent SLN biopsy and completion lymphadenectomy if tumor-positive SLN were found. Kaplan-Meier survival analysis and univariate and multivariate analyses were performed to evaluate factors predictive of disease-free survival (DFS), local and in-transit recurrence-free survival (LITRFS), and overall survival (OS).RESULTS: A total of 2,500 patients were included in this analysis with a median follow-up period of 68 months. Anatomic locations included head, neck, trunk, upper extremity, and lower extremity. Age, Breslow thickness, and percentage of patients with a positive SLN were significantly different by anatomic location on univariate analysis, as were positive SLN status, presence of regression, sex, and histologic subtype (P < .0001). On multivariate analysis, anatomic location was an independent predictor of SLN status (P < .0001), DFS (P = .045), LITRFS (P = .023), and OS (P < .0001). By Kaplan-Meier analysis, anatomic location was associated significantly with DFS, LITRFS, and OS.CONCLUSIONS: Anatomic location of the primary melanoma is an important independent predictor of SLN status and prognosis. Patients with primary melanomas of the head/neck and trunk have a worse prognosis than primary melanomas of other anatomic locations. (C) 2011 Elsevier Inc. All rights reserved.