Cormier Janice N, Xing Yan, Feng Lei, Huang Xuelin, Davidson Latunya, Gershenwald Jeffrey E, Lee Jeffrey E, Mansfield Paul F, Ross Merrick I
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2006 May 1;106(9):2012-20. doi: 10.1002/cncr.21835.
The natural history of metastatic melanoma in lymph nodes in the absence of a known primary site (MUP) has been defined poorly; thus, treatment guidelines for patients with MUP are not clear-cut.
The authors conducted a retrospective analysis of consecutive patients with melanoma (from 1990 to 2001) who underwent surgical resection for melanoma metastatic to regional lymph nodes. Among those patients, 71 patients with MUP and 466 control patients who had regional lymph node metastases of similar stage with a known primary site were identified. Associations between clinicopathologic factors and survival were estimated by using the Cox proportional hazards model.
After they underwent lymph node dissection, patients with MUP were classified with N1b disease (47%), N2b disease (14%), or N3 disease (39%). With a median follow-up of 7.7 years, the 5-year and 10-year overall survival rates were 55% and 44%, respectively, for patients with MUP, compared with 42% and 32%, respectively, for the control group (P = .04). In multivariate analyses, age 50 years or older, male gender, and N2b or N3 disease status were identified as adverse prognostic factors, and MUP was identified as a favorable prognostic factor (hazard ratio, 0.61; 95% confidence interval, 0.42-0.86; P = .006) for overall survival.
The relatively favorable long-term survival of patients with MUP in the current study suggested that patients with MUP have a natural history that is similar to (if not better than) the survival of many patients with Stage III disease. Therefore, patients with MUP should be treated with an aggressive surgical approach with curative intent and should be considered for Stage III adjuvant therapy protocols. Cancer 2006. (c) 2006 American Cancer Society.
在无已知原发部位的情况下，淋巴结转移性黑色素瘤（MUP）的自然病程尚未明确界定；因此，MUP患者的治疗指南并不明确。
作者对1990年至2001年间因黑色素瘤转移至区域淋巴结而接受手术切除的连续黑色素瘤患者进行了回顾性分析。在这些患者中，确定了71例MUP患者和466例具有已知原发部位、处于相似分期的区域淋巴结转移对照患者。采用Cox比例风险模型估计临床病理因素与生存之间的关联。
在接受淋巴结清扫术后，MUP患者被分类为N1b期疾病（47%）、N2b期疾病（14%）或N3期疾病（39%）。中位随访7.7年，MUP患者的5年和10年总生存率分别为55%和44%，而对照组分别为42%和32%（P = 0.04）。在多变量分析中，年龄50岁及以上、男性性别以及N2b或N3期疾病状态被确定为不良预后因素，而MUP被确定为总生存的有利预后因素（风险比，0.61；95%置信区间，0.42 - 0.86；P = 0.006）。
本研究中MUP患者相对良好的长期生存表明，MUP患者的自然病程与许多III期疾病患者的生存相似（如果不比其更好的话）。因此，MUP患者应采用具有治愈意图的积极手术方法进行治疗，并应考虑纳入III期辅助治疗方案。癌症2006。（c）2006美国癌症协会。
