Livestro Daan P, Kaine Emily M, Michaelson James S, Mihm Martin C, Haluska Frank G, Muzikansky Alona, Sober Arthur J, Tanabe Kenneth K
Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Cancer. 2007 Aug 1;110(3):614-24. doi: 10.1002/cncr.22818.
Melanoma in the first 2 decades of life is rare and is less well characterized than melanoma in adults. Previously published comparisons of melanoma of the young (age <or=20 years) and in adults have been biased by the observation that primary melanomas of the young are significantly thicker on average than adult melanomas. In this study, the use of an adult control group that was matched for tumor thickness adjusted for this bias and allowed for a comparison of the biology of pediatric melanoma and adult melanoma.
The authors identified young patients with melanoma who were treated at their institution between 1971 and 2002, and matched each patient by thickness and year of diagnosis to 2 adult control patients with melanoma. The study group of 73 young patients with melanoma (aged <or=20 years) was compared with to 146 adult case-matched control patients for clinical presentation, treatment, and clinically relevant outcome parameters, including disease-free and cause-specific survival. A subset of pediatric patients aged <or=13 years also was analyzed against case-matched adult controls.
The demographics and clinical presentation of the 2 groups were similar. Of the young patients with melanoma who underwent pathologic staging of clinically negative lymph nodes by either elective lymph node dissection or lymphatic mapping/sentinel lymph node biopsy, 11 of 25 patients (44%) had positive lymph nodes compared with 11 of 46 patients (23.9%) among the adults. The overall incidence of positive lymph nodes was 17.8% in young melanoma patients and 9.6% in thickness-matched adult control patients. Nonetheless, 10-year cause-specific survival was similar between young melanoma patients and adult melanoma patients (89.4% and 79.3%, respectively). No significant differences were observed comparing young patients with melanoma aged <13 years versus age >13 years.
Melanoma of the young had some important differences and similarities relative to adult melanoma. Lymph node metastases were more prevalent in young patients with melanoma compared with adult (thickness-matched) control patients; however, the 5- and 10-year survival rates were similar.
20岁前发生的黑色素瘤较为罕见，其特征不如成人黑色素瘤明确。此前发表的关于年轻（年龄≤20岁）黑色素瘤与成人黑色素瘤的比较研究存在偏差，因为观察发现年轻患者的原发性黑色素瘤平均厚度显著高于成人黑色素瘤。在本研究中，通过使用与肿瘤厚度匹配的成人对照组来校正这一偏差，从而能够对儿童黑色素瘤和成人黑色素瘤的生物学特性进行比较。
作者确定了1971年至2002年间在其机构接受治疗的年轻黑色素瘤患者，并根据厚度和诊断年份将每位患者与2名患有黑色素瘤的成人对照患者进行匹配。将73名年轻黑色素瘤患者（年龄≤20岁）的研究组与146名年龄匹配的成人对照患者在临床表现、治疗及临床相关结局参数（包括无病生存期和病因特异性生存期）方面进行比较。还对一组年龄≤13岁的儿科患者与年龄匹配的成人对照进行了分析。
两组的人口统计学特征和临床表现相似。在通过选择性淋巴结清扫术或淋巴管造影/前哨淋巴结活检对临床阴性淋巴结进行病理分期的年轻黑色素瘤患者中，25例患者中有11例（44%）淋巴结阳性，而成人组46例患者中有11例（23.9%）淋巴结阳性。年轻黑色素瘤患者淋巴结阳性的总体发生率为17.8%，厚度匹配的成人对照患者为9.6%。尽管如此，年轻黑色素瘤患者和成人黑色素瘤患者的10年病因特异性生存率相似（分别为89.4%和79.3%）。年龄＜13岁与年龄＞13岁的年轻黑色素瘤患者之间未观察到显著差异。
年轻黑色素瘤与成人黑色素瘤相比有一些重要的异同点。与成人（厚度匹配）对照患者相比，年轻黑色素瘤患者的淋巴结转移更为普遍；然而，5年和10年生存率相似。
