A multifactorial analysis of melanoma. II. Prognostic factors in patients with stage I (localized) melanoma.
A multifactorial analysis of melanoma. II. Prognostic factors in patients with stage I (localized) melanoma.
复制标题
黑色素瘤的多因素分析。
作者：
Charles M. Balch;S. Soong;Tariq M. Murad;A. L. Ingalls;W. Maddox
I期黑色素瘤包括生物学行为的非凡多样性。在这样一个环境中，许多参数似乎影响生存，多因素分析使用考克斯的回归模型是一个有价值的统计模型。使用计算机数据库的394例临床I期黑色素瘤患者在该机构在过去的20年中，多因素分析被用来比较11个参数的相对预后强度。两个病理因素（肿瘤厚度和溃疡）和两个临床因素（初始手术治疗和解剖位置）被确定为主要的预后变量。同时检查的其他对生存率没有额外预测影响的因素包括浸润水平、色素沉着、生长模式、淋巴细胞浸润、病理状态、性别和年龄。黑色素瘤厚度是预测I期黑色素瘤患者生存率的最重要因素（P <10（-8））。该参数易于测量，并提供了临床隐匿性区域和远处转移的定量估计。与其他使用单因素分析的报告相反，在考虑其他变量后，初始手术治疗的类型确实影响生存率。因此，多因素分析支持以下观察结果：中等厚度黑色素瘤厚度为1.5至3.99 mm的患者在广泛切除黑色素瘤和选择性淋巴结清扫的情况下8年生存率为78%，而如果仅广泛切除相同厚度的黑色素瘤，则无患者生存超过8年。在比较黑色素瘤患者的治疗方案和预后因素时，多因素分析是一种有用且重要的统计方法。
Stage I melanoma encompasses an extraordinary diversity of biologic behavior. In such a setting where numerous parameters appear to influence survival, a multifactorial analysis using Cox's regression model is a valuable statistical model. Using a computerized data base of 394 clinical stage I melanoma patients treated at this institution during the past 20 years, a multifactorial analysis was used to compare the relative prognostic strength of 11 parameters. Two pathological factors (tumor thickness and ulceration) and two clinial factors (initial surgical treatment and anatomic location) were identified as the dominant prognostic variables. Other factors examined simultaneously that did not provide additional predictive influence on survival included the level of invasion, pigmentation, growth pattern, lymphocyte infiltration, pathological state, sex, and age. Melanoma thickness was the most important factor for predicting survival in patients with stage I melanoma (P less than 10(-8). This parameter is easy to measure and provides a quantitative estimate of clinically occult regional and distant metastases. Contrary to other reports using single factor analysis, the type of initial surgical treatment, in fact, did influence survival after other variables were taken into consideration. Thus the multifactorial analysis supports the observation that patients with intermediate thickness melanoma thickness of 1.5 to 3.99 mm had a 78% 8-year survival rate with wide excision of the melanoma and elective node dissection, while none survived more than 8 years if a melanoma of the same thickness was only widely excised. Multifactorial analysis is a useful and important statistical method when comparing treatment alternatives and prognostic factors in patients with melanoma.