Schoenlaub P, Sarraux A, Grosshans E, Heid E, Cribier B
Clinique Dermatologique de Strasbourg, Hôpitaux Universitaires de Strasbourg, CHRU, 1, place de l'Hôpital, 67091 Strasbourg.
Ann Dermatol Venereol. 2001 Dec;128(12):1310-5.
Cutaneous metastatic disease is uncommon and the outcome after cutaneous metastasis has rarely been thoroughly studied. The objective of this work was to study the survival after diagnosis of cutaneous metastasis in a large series of patients and to evaluate survival according to the type of cancer.
This retrospective study was conducted out in the Laboratoire d'Histo-pathologie Cutanée of Strasbourg. Between 1950 to 1996, 228 patients with cutaneous metastasis were diagnosed on the basis of typical histopathology, confirmed by two dermatopathologists. We excluded lymphoma or leukaemia with secondary skin involvement. Medical and demographic data were collected from hospital data, and the "Registre du Cancer du Bas-Rhin". The type of neoplasm, the time of diagnosis of primary cancer and the time of death (or survival at 12/31/1996) was established in 200 patients, 99 men and 101 women with a mean age 62.4 +/- 13 years. We found 64 cases of breast carcinoma, 36 cases of lung carcinoma, 31 cases of melanoma and 69 cases of other cancers. Long term actuarial survival after cutaneous metastasis was calculated using by the Kaplan-Meier method.
The median survival after cutaneous metastasis was 6.5 months (mean 22.8 +/- 43.8 months). The mortality rate was 13 p. 100 at 1 month, 48 p. 100 at 6 months and 64.5 p. 100 at 12 months. Median survival was calculated according to the primary neoplasm: breast carcinoma: 13.8 months, melanoma: 13.5 months, lung carcinoma: 2.9 months (36 cases). The outcome of patients with cutaneous metastasis of lung carcinoma was worse than those with melanoma (p < 10(-4)) and breast cancer (p < 10(-4)). Survival after cutaneous metastasis of other cancers could not be compared because of the small size of the subgroups: median survival after cutaneous metastasis of non cutaneous squamous cell carcinoma of the head and neck: 8.8 months (5 cases), cutaneous squamous cell carcinoma: 6.5 months (12 cases), carcinoma of oesophagus: 4.7 months (2 cases), colo-rectal cancer: 4.4 months (9 cases), pancreatic cancer: 3.3 months (2 cases), stomach cancer: 1.2 months (7 cases) and liver and gall bladder carcinoma: < 1 month (3 cases). Survival beyond 10 years was observed in 9 patients: 3 melanoma, 2 breast cancers, 2 prostatic carcinomas, 1 larynx carcinoma and 1 cutaneous squamous cell carcinoma.
This is the first study in which the survival after the occurrence of skin metastasis was systematically analysed in a large series of patients. It shows that half of patients with cutaneous metastasis die within the first 6 months after the diagnosis. Those cases due to lung carcinoma have the poorest prognosis.
皮肤转移性疾病并不常见，且皮肤转移后的预后很少得到深入研究。本研究的目的是在大量患者中研究皮肤转移诊断后的生存期，并根据癌症类型评估生存期。
本回顾性研究在斯特拉斯堡皮肤组织病理学实验室进行。1950年至1996年间，228例皮肤转移患者经两名皮肤病理学家确诊，基于典型组织病理学诊断。我们排除了继发皮肤受累的淋巴瘤或白血病。从医院数据和“下莱茵省癌症登记处”收集医疗和人口统计学数据。200例患者（99名男性和101名女性，平均年龄62.4±13岁）确定了肿瘤类型、原发癌诊断时间和死亡时间（或至1996年12月31日的生存情况）。我们发现64例乳腺癌、36例肺癌、31例黑色素瘤和69例其他癌症。采用Kaplan-Meier法计算皮肤转移后的长期精算生存率。
皮肤转移后的中位生存期为6.5个月（平均22.8±43.8个月）。1个月时死亡率为13‰，6个月时为48‰，12个月时为64.5‰。根据原发肿瘤计算中位生存期：乳腺癌：13.8个月，黑色素瘤：13.5个月，肺癌：2.9个月（36例）。肺癌皮肤转移患者的预后比黑色素瘤患者（p<10⁻⁴）和乳腺癌患者（p<10⁻⁴）差。由于亚组规模较小，其他癌症皮肤转移后的生存期无法比较：头颈部非皮肤鳞状细胞癌皮肤转移后的中位生存期：8.8个月（5例），皮肤鳞状细胞癌：6.5个月（12例），食管癌：4.7个月（2例），结直肠癌：4.4个月（9例），胰腺癌：3.3个月（2例），胃癌：1.2个月（7例），肝胆癌：<1个月（3例）。9例患者生存期超过10年：3例黑色素瘤、2例乳腺癌、2例前列腺癌、1例喉癌和1例皮肤鳞状细胞癌。
这是第一项对大量患者皮肤转移发生后的生存期进行系统分析的研究。结果显示，一半的皮肤转移患者在诊断后的前6个月内死亡。肺癌导致的皮肤转移预后最差。
