Carlson J Andrew
Division of Dermatology, Albany Medical College, New York 12208, USA.
Am J Dermatopathol. 2003 Aug;25(4):291-9. doi: 10.1097/00000372-200308000-00003.
Tumor doubling time, estimated using clinical data, is one factor used to determine who will benefit from surgery for patients with pulmonary metastatic melanoma. Reported herein are the tumor doubling times of four primary cutaneous melanomas in which the diagnosis of melanoma had been delayed, and their metastases (3 of 4). The median/mean tumor doubling times for primary melanoma and metastatic melanoma was 94/144 days (range 50-377) and 33/64 days (range 8-212), respectively. By paired t test, metastatic tumor doubling time was significantly faster than primary tumor doubling time (P = 0.01). Extrapolating the growth curves of metastatic melanoma to the point of onset of metastasis revealed that dissemination of tumor cells occurred well before first clinical presentation and symptoms in two cases, and in one case, during the interval between clinical presentation and complete excision of the primary. At the opposite pole, extrapolated growth curves for slow tumor doubling time melanoma demonstrated that long-term follow up (>10 years) is required to determine whether patients have been cured of melanoma or not. Overall, these estimates of melanoma tumor doubling time validate the concept of tumor progression, reinforce the tenet of early detection and curative excision, and can explain the phenomenon of late onset of metastases, respectively.
利用临床数据估算的肿瘤倍增时间是确定哪些肺转移性黑色素瘤患者将从手术中获益的一个因素。本文报告了4例原发性皮肤黑色素瘤的肿瘤倍增时间，这些病例中黑色素瘤的诊断有所延迟，还报告了它们的转移情况（4例中的3例）。原发性黑色素瘤和转移性黑色素瘤的中位/平均肿瘤倍增时间分别为94/144天（范围50 - 377天）和33/64天（范围8 - 212天）。通过配对t检验，转移性肿瘤倍增时间显著快于原发性肿瘤倍增时间（P = 0.01）。将转移性黑色素瘤的生长曲线外推至转移开始点显示，在2例中肿瘤细胞的播散在首次临床表现和症状出现之前就已发生，在1例中，发生在原发性肿瘤临床表现和完整切除之间的间隔期。在另一端，肿瘤倍增时间缓慢的黑色素瘤的外推生长曲线表明，需要长期随访（>10年）来确定患者是否已治愈黑色素瘤。总体而言，这些黑色素瘤肿瘤倍增时间的估计分别验证了肿瘤进展的概念，强化了早期检测和根治性切除的原则，并可以解释转移发生较晚的现象。
