Pawlik Timothy M, Ross Merrick I, Johnson Marcella M, Schacherer Christopher W, McClain Dana M, Mansfield Paul F, Lee Jeffrey E, Cormier Janice N, Gershenwald Jeffrey E
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Unit 444, PO Box 301402, Houston, Texas 77230-1402, USA.
Ann Surg Oncol. 2005 Aug;12(8):587-96. doi: 10.1245/ASO.2005.05.025. Epub 2005 Jun 16.
In-transit recurrence is a unique and uncommon pattern of treatment failure in patients with melanoma. Little information exists concerning the incidence, predictors, and natural history of in-transit disease since the introduction of sentinel lymph node biopsy (SLNB).
Between 1991 and 2001, 1395 patients with primary melanoma underwent SLNB. Univariate and multivariate logistic regression analyses were performed to examine the association among known clinicopathologic factors, in-transit recurrence, and distant metastatic failure after the development of in-transit disease.
With a median follow-up of 3.9 years, 241 patients (17.3%) experienced disease recurrence, including 91 (6.6%) who developed in-transit recurrence. Independent predictors of in-transit recurrence included age >50 years, a lower extremity location of the primary tumor, Breslow depth, ulceration, and sentinel lymph node (SLN) status. Of the 69 patients who presented with in-transit disease as the sole site of first recurrence, 39 developed distant disease. By univariate analysis, predictors of distant failure among patients with in-transit disease included SLN status, largest metastatic focus in the SLN >2.5 mm2, subcutaneous location of in-transit disease, in-transit tumor size > or = 2 cm, and a disease-free interval before in-transit recurrence of <12 months. In-transit tumor size remained a significant predictor of distant metastasis by multivariate analysis (odds ratio, 9.69).
The overall incidence of in-transit metastases in patients undergoing SLNB is low and does not seem to have increased since the introduction of the SLNB technique. In-transit recurrence, as well as subsequent distant metastatic failure, can be predicted on the basis of adverse tumor factors and SLN status.
移行转移是黑色素瘤患者一种独特且不常见的治疗失败模式。自前哨淋巴结活检（SLNB）引入以来，关于移行转移疾病的发病率、预测因素和自然史的信息较少。
1991年至2001年间，1395例原发性黑色素瘤患者接受了SLNB。进行单因素和多因素逻辑回归分析，以研究已知临床病理因素、移行转移复发以及移行转移疾病发生后远处转移失败之间的关联。
中位随访3.9年，241例患者（17.3%）出现疾病复发，其中91例（6.6%）发生移行转移复发。移行转移复发的独立预测因素包括年龄>50岁、原发肿瘤位于下肢、Breslow深度、溃疡形成以及前哨淋巴结（SLN）状态。在69例以移行转移疾病作为首次复发唯一部位的患者中，39例发生远处疾病。单因素分析显示，移行转移疾病患者远处转移失败的预测因素包括SLN状态、SLN中最大转移灶>2.5 mm2、移行转移疾病位于皮下、移行转移肿瘤大小≥2 cm以及移行转移复发前无病间期<12个月。多因素分析显示，移行转移肿瘤大小仍然是远处转移的重要预测因素（比值比，9.69）。
接受SLNB的患者中移行转移的总体发生率较低，自SLNB技术引入以来似乎并未增加。移行转移复发以及随后的远处转移失败可根据不良肿瘤因素和SLN状态进行预测。
