Kirkwood John M, Tarhini Ahmad A
Division of Medical Oncology, University of Pittsburgh, 200 Lothrop Street, 15123 Pittsburg, Pennsylvania.
Forum (Genova). 2003;13(2):127-40; quiz 187-8.
The incidence of melanoma continues to rise at a rate greater than all other cancers. Survival in melanoma varies widely by stage, and is affected by a number of prognostic factors including tumour thickness, ulceration and lymph node involvement. New AJCC staging criteria adopted in the 6(th) edition reflect the prognostic value of tumour ulceration, the number of positive lymph nodes as a better prognostic indicator than the size of nodal metastasis, and the similar prognostic value provided by nodal, in-transit and local recurrences. It also recognises the pathologic information about staging provided by lymphatic mapping and sentinel lymphadenectomy. High-risk resected melanoma is defined as disease that after surgery is at higher than 40 to 50% risk of recurrence and death. The urgency to the effort to develop effective therapy for melanoma has led to a wide variety of approaches that have been tested over the years in the high-risk adjuvant setting. Among the many therapeutic modalities tested, the only agent that has shown a significant and reproducible benefit in terms of survival and relapse-free interval has been high-dose interferon-alpha2b. We here review the evidence that has led to the regulatory approval of this regimen, as well as ongoing studies using high-dose interferon-alpha in the high-risk adjuvant setting. We also present selected ongoing trials testing potential future therapies that may prove effective for patients with high-risk resected melanoma.
黑色素瘤的发病率持续以高于所有其他癌症的速度上升。黑色素瘤患者的生存率因分期不同而有很大差异，并受多种预后因素影响，包括肿瘤厚度、溃疡和淋巴结受累情况。美国癌症联合委员会（AJCC）第6版采用的新分期标准反映了肿瘤溃疡的预后价值、阳性淋巴结数量作为比淋巴结转移大小更好的预后指标，以及淋巴结、移行转移和局部复发所提供的相似预后价值。它还认可了通过淋巴绘图和前哨淋巴结切除术提供的关于分期的病理信息。高危切除型黑色素瘤定义为术后复发和死亡风险高于40%至50%的疾病。为黑色素瘤开发有效治疗方法的紧迫性促使多年来在高危辅助治疗环境中测试了各种各样的方法。在测试的众多治疗方式中，唯一在生存和无复发生存期方面显示出显著且可重复益处的药物是高剂量干扰素-α2b。我们在此回顾了导致该方案获得监管批准的证据，以及在高危辅助治疗环境中使用高剂量干扰素-α的正在进行的研究。我们还介绍了一些正在进行的试验，这些试验正在测试可能对高危切除型黑色素瘤患者有效的潜在未来疗法。
