Binder M, Dolezal I, Wolff K, Pehamberger H
Department of Dermatology I, University of Vienna, Austria.
J Invest Dermatol. 1992 Aug;99(2):180-3. doi: 10.1111/1523-1747.ep12616803.
At present, tumor invasion represents the most reliable prognostic factor for primary malignant melanoma. The 10-year survival rate of "thin" melanomas (Breslow less than 0.76 mm) is more than 95%, but approximately 5% of these low-risk tumors do metastasize. In an attempt to determine prognostic markers for "thin" melanomas we investigated the volume-weighted mean nuclear volume (Vv) of primary melanomas with tumor invasions below 0.76 mm in 32 patients. Ten of these patients had developed melanoma metastases within a mean follow-up period of 49 months; 22 patients who had not developed metastases and who were comparable with regard to clinical and histologic criteria as well as to follow-up period were selected as a comparison group. Vv was determined by computer-assisted image analysis (IBAS 20, Kontron, Germany) on hematoxylin-eosin-stained sections employing stereologic estimation of the volume-weighted mean nuclear volume. In addition, two-dimensional morphometric parameters (nuclear area and shape factors) as well as clinical (sex, age, location) and histologic characteristics (Breslow's thickness, Clark's level, and growth patterns) were recorded. The mean Vv (+/- SD) of primary melanomas with subsequent metastatic course was 273 microns 3 (+/- 81.3), whereas primary melanoma lesions without subsequent metastases exhibited a significantly lower Vv of 154 microns 3 (+/- 25.3) (p = 0.0008). On the other hand, two-dimensional morphometric and clinical and histologic parameters did not correlate with prognosis. Vv thus seems to represent a powerful and independent prognostic marker for "thin" primary melanomas. Assessment of Vv may provide a valuable tool in selecting patients with high-risk stage I, Breslow less than 0.76 mm, melanoma for adjuvant therapy.
目前，肿瘤侵袭是原发性恶性黑色素瘤最可靠的预后因素。“薄型”黑色素瘤（ Breslow厚度小于0.76 mm）的10年生存率超过95%，但这些低风险肿瘤中约5%会发生转移。为了确定“薄型”黑色素瘤的预后标志物，我们研究了32例肿瘤侵袭深度低于0.76 mm的原发性黑色素瘤的体积加权平均核体积（Vv）。这些患者中有10例在平均49个月的随访期内发生了黑色素瘤转移；选择22例未发生转移且在临床、组织学标准以及随访期方面具有可比性的患者作为对照组。通过计算机辅助图像分析（德国康强公司的IBAS 20），在苏木精-伊红染色切片上采用体视学方法估计体积加权平均核体积来确定Vv。此外，还记录了二维形态学参数（核面积和形状因子）以及临床特征（性别、年龄、部位）和组织学特征（Breslow厚度、Clark分级和生长模式）。后续发生转移的原发性黑色素瘤的平均Vv（±标准差）为273立方微米（±81.3），而未发生转移的原发性黑色素瘤病变的Vv显著较低，为154立方微米（±25.3）（p = 0.0008）。另一方面，二维形态学参数以及临床和组织学参数与预后无关。因此，Vv似乎是“薄型”原发性黑色素瘤一个有力且独立的预后标志物。评估Vv可能为选择I期高风险、Breslow厚度小于0.76 mm的黑色素瘤患者进行辅助治疗提供一个有价值的工具。
