Prediction of melanoma metastasis by the Shields index based on lymphatic vessel density
Prediction of melanoma metastasis by the Shields index based on lymphatic vessel density
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DOI：
10.1186/1471-2407-10-208
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发表时间：
2010-05-17
期刊：
影响因子：
3.8
通讯作者：
Bates, David O.
中科院分区：
文献类型：
--
作者：
Emmett, Maxine S.;Symonds, Kirsty E.;Bates, David O.
背景：黑色素瘤通常表现为最初的皮肤损害，没有转移的证据。相当大比例的患者会发生随后的局部、区域性或远处转移，有时是在最初的病变切除多年后。目前识别早期区域转移的最有效的分期方法是前哨淋巴结活检(SLNB)，这种方法具有侵袭性，并不是没有并发症，虽然改善了分期，但可能并不能提高总体生存率。淋巴密度、Breslow‘s厚度和有无淋巴侵犯被Shields等人在一个病例组中提出作为预后指标。方法：我们对102例恶性黑色素瘤患者进行了回顾性分析，以评估Shields’s指数，并与现有的指标进行比较。结果：Shields‘s指数在90%的转移患者和84%的无转移患者中准确地预测了预后。在这些方面，希尔兹指数比厚度或淋巴密度更具预测性。在24名患者中，交替淋巴测量(热点分析)也是有效的。结论：Shields指数是一种基于原发灶周围淋巴管的非侵入性分析，可以准确地预测预后，是一种简单、有用的恶性黑色素瘤预后评估工具。
Background: Melanoma usually presents as an initial skin lesion without evidence of metastasis. A significant proportion of patients develop subsequent local, regional or distant metastasis, sometimes many years after the initial lesion was removed. The current most effective staging method to identify early regional metastasis is sentinel lymph node biopsy (SLNB), which is invasive, not without morbidity and, while improving staging, may not improve overall survival. Lymphatic density, Breslow's thickness and the presence or absence of lymphatic invasion combined has been proposed to be a prognostic index of metastasis, by Shields et al in a patient group.Methods: Here we undertook a retrospective analysis of 102 malignant melanomas from patients with more than five years follow-up to evaluate the Shields' index and compare with existing indicators.Results: The Shields' index accurately predicted outcome in 90% of patients with metastases and 84% without metastases. For these, the Shields index was more predictive than thickness or lymphatic density. Alternate lymphatic measurement (hot spot analysis) was also effective when combined into the Shields index in a cohort of 24 patients.Conclusions: These results show the Shields index, a non-invasive analysis based on immunohistochemistry of lymphatics surrounding primary lesions that can accurately predict outcome, is a simple, useful prognostic tool in malignant melanoma.