Nagore Eduardo, Oliver Vicente, Botella-Estrada Rafael, Moreno-Picot Salvador, Insa Amelia, Fortea José M
Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.
Melanoma Res. 2005 Jun;15(3):169-77. doi: 10.1097/00008390-200506000-00005.
The aim of this study was to determine independent clinical and pathological prognostic factors for overall and disease-free survival in Spanish melanoma patients. Eight hundred and twenty-three patients with localized melanoma and complete clinical and pathological information were evaluated. The age at diagnosis, gender, location, tumour thickness, invasion level, ulceration, histological subtype, inflammatory infiltrate, mitotic rate, vascular invasion, microscopic satellitosis, regression and cell type were all included. Univariate and multivariate Cox regression analyses were performed for overall and disease-free survival. Gender, histological subtype, tumour thickness, invasion level, ulceration, inflammatory infiltrate, microscopic satellitosis, vascular invasion and mitotic rate were related to overall and disease-free survival in univariate analysis. Age and location were only related to disease-free survival. Only tumour thickness, vascular invasion and gender exhibited independent significance for overall survival in multivariate analysis. For disease-free survival, tumour thickness, location, mitotic rate, vascular invasion and microscopic satellitosis were the sole independent factors. It can be concluded that the Breslow thickness remains the most significant prognostic factor for the survival of patients with localized cutaneous melanoma. Our results support the inclusion of microscopic satellitosis and vascular invasion in the current American Joint Committee on Cancer (AJCC) staging system, although further studies evaluating their separate influence are needed. Mitotic rate is confirmed as an objective and independent predictor of disease-free survival for melanoma patients that should be considered in further revisions of the mentioned staging system.
本研究的目的是确定西班牙黑色素瘤患者总生存期和无病生存期的独立临床及病理预后因素。对823例局限性黑色素瘤患者进行了评估，这些患者具备完整的临床和病理信息。纳入的因素包括诊断时的年龄、性别、部位、肿瘤厚度、浸润水平、溃疡、组织学亚型、炎症浸润、有丝分裂率、血管侵犯、微小卫星灶、消退及细胞类型。对总生存期和无病生存期进行单因素和多因素Cox回归分析。单因素分析显示，性别、组织学亚型、肿瘤厚度、浸润水平、溃疡、炎症浸润、微小卫星灶、血管侵犯和有丝分裂率与总生存期和无病生存期相关。年龄和部位仅与无病生存期相关。多因素分析中，仅肿瘤厚度、血管侵犯和性别对总生存期具有独立意义。对于无病生存期，肿瘤厚度、部位、有丝分裂率、血管侵犯和微小卫星灶是唯一的独立因素。可以得出结论，Breslow厚度仍然是局限性皮肤黑色素瘤患者生存的最重要预后因素。我们的结果支持将微小卫星灶和血管侵犯纳入当前美国癌症联合委员会（AJCC）分期系统，尽管需要进一步研究评估它们各自的影响。有丝分裂率被确认为黑色素瘤患者无病生存期的客观独立预测因素，在上述分期系统的进一步修订中应予以考虑。
