Bachaud J M, Shubinski R, Boussin G, Chevreau C, David J M, Viraben R, Bonafé J L, Daly N J
Department of Radiotherapy, Centre Claudius Regaud, Toulouse, France.
Eur J Surg Oncol. 1992 Oct;18(5):442-8.
Two hundred and nineteen patients admitted to the Centre Claudius Regaud over a 14-year period for a stage I cutaneous malignant melanoma were retrospectively evaluated for loco-regional recurrence rates, risk factors and survival rates following wide primary excision. Five and 8 year survival rates corrected for deaths owing to concurrent illness were 77% and 73%. The loco-regional control rate was 69% (151/219). Distant metastases occurred in 59% (40/68) of patients who had a loco-regional recurrence, versus 11% (16/151) of patients when loco-regional control was obtained (P < 0.001). Multivariate analysis was used to ascertain which risk factors act independently as predictors of poor loco-regional control. Anatomical location of the primary ('head and neck-trunk-hands and feet' vs 'proximal limb') and thickness formed the best model in this respect among 11 prognostic factors studied. Since loco-regional recurrence may be associated with an increased risk of distant metastatic disease, we advocate the use of elective regional lymph node dissection in stage I patients at high risk of loco-regional recurrence in the hope that a portion of these patients may have increased survival owing to lack of development of widespread metastases.
对14年间收治于克劳迪乌斯·雷戈中心的219例I期皮肤恶性黑色素瘤患者进行回顾性评估，以分析广泛原发性切除术后的局部区域复发率、危险因素和生存率。校正因并发疾病导致的死亡后，5年和8年生存率分别为77%和73%。局部区域控制率为69%（151/219）。局部区域复发的患者中59%（40/68）发生远处转移，而获得局部区域控制的患者中这一比例为11%（16/151）（P<0.001）。采用多因素分析确定哪些危险因素可独立作为局部区域控制不佳的预测因素。在研究的11个预后因素中，原发灶的解剖位置（“头颈部-躯干-手足”与“近侧肢体”）和厚度构成了这方面的最佳模型。由于局部区域复发可能与远处转移性疾病风险增加相关，我们主张对有局部区域复发高风险的I期患者行选择性区域淋巴结清扫术，希望部分患者因未发生广泛转移而提高生存率。
