Ishihara Kazuyuki, Saida Toshiaki, Otsuka Fujio, Yamazaki Naoya
The Institute for Analysis of Prognostic Factors in Skin Cancer, 3-14-9 Tsukishima, Chuo-ku, Tokyo, 104-0052, Japan,
Int J Clin Oncol. 2008 Feb;13(1):33-41. doi: 10.1007/s10147-007-0751-1. Epub 2008 Feb 29.
In the previous report of the Prognosis and Statistical Investigation Committee of the Japanese Skin Cancer Society, we tabulated data on patients with malignant melanoma who had been registered at major medical institutions (22 institutions on average) in Japan over 5-year periods from 1987 to 1991 (group A) and from 1992 to 1996 (group B). In the present study, patients registered from 1997 to 2001 (group C) were investigated and the data were compared with findings obtained by the subsequent follow-up of groups A and B.
The numbers of melanoma patients registered were: 545 in group A (1987-1991), 699 in group B (1992-1996), and 821 in group C (1997-2001). Because the International Union Against Cancer (UICC) TNM and stage classifications for malignant melanoma were changed substantially in 2002, analyses in the present investigation were performed according to the new classifications. The Kaplan-Meier method was used to draw survival curves, and the log-rank test was used to assess the significance of differences in survival. In addition, the numbers of patients with various kinds of skin malignancies, including not only malignant melanoma but also basal cell carcinoma, squamous cell carcinoma, mycosis fungoides, actinic keratosis, Bowen's disease, and Paget's disease, registered at approximately 100 medical institutions in Japan from 1987 to 2001, were also investigated and data were tabulated.
The nationwide survey of Japanese patients with malignant skin tumors from 1987 to 2001 showed that the most prevalent skin tumor was basal cell carcinoma, which increased year by year, followed by squamous cell carcinoma, and then by malignant melanoma. The following results were obtained from the data for melanoma patients registered at major institutions from 1987 to 2001. (1) The overall 10-year survival rates for melanoma patients in each chronological group were ranked as: group C > B > A, although only the difference between groups C and A was statistically significant. (2) The male-to-female ratio ranged from 1: 0.97 to 1: 1.14, and the survival rate of female patients was higher than that of male patients (the 140-month survival rate was 70.6% in females and 60% in males). (3) Assessment of the age distribution showed that the number of patients increased rapidly from ages 40-49 years and reached a peak at around 60 years in all three groups. (4) The sole of the foot was the most common site of melanoma in both males and females, while melanomas on the lower limbs were also prevalent in females. (5) Acral lentiginous melanoma (ALM) was the most common type in all three groups, accounting for nearly 50% of the patients in each group. The number of patients with superficial spreading melanoma (SSM) increased steadily over time and exceeded the number of patients with nodular melanoma (NM) in group C. The prognosis of NM was the worst, while that of SSM was the most favorable. (6) The proportion of stage I patients was larger in group C than in groups A and B, but no significant difference among the groups was observed in the proportions of stage II, III, and IV patients. For patients in stage III, the overall survival rate was higher in group C than that in group A or B, while there was no apparent difference in survival between the groups for patients in stage I or II. For patients in stage IV, the survival rate in group C was slightly lower than that in group A or B. (7) In group C, the overall survival rates for substages III A, B, and C were ranked as III A > III B > III C. (8) The overall survival rates for stage IV M1a, M1b, and M1c were ranked as M1a > M1b > M1c. In group C, the overall survival rate of stage IV patients with a normal serum lactic dehydrogenase (LDH) level was higher than that of patients with elevated LDH values. (9) Evaluation of the effects of some therapeutic procedures (prophylactic lymph node dissection and chemotherapy with and without interferon-beta) on the survivals of patients with melanoma was inconclusive and suggested the need for more studies in this area.
In Japan, the number of patients with malignant skin tumors has increased year by year. The prognosis of patients with advanced malignant melanoma remains extremely poor, but that of patients in stage III has shown an improvement.
在日本皮肤癌协会预后与统计调查委员会的上一份报告中，我们汇总了1987年至1991年（A组）以及1992年至1996年（B组）这两个5年期间在日本主要医疗机构（平均22家机构）登记的恶性黑色素瘤患者的数据。在本研究中，我们调查了1997年至2001年登记的患者（C组），并将数据与A组和B组后续随访的结果进行了比较。
登记的黑色素瘤患者数量分别为：A组（1987 - 1991年）545例，B组（1992 - 1996年）699例，C组（1997 - 2001年）821例。由于国际抗癌联盟（UICC）对恶性黑色素瘤的TNM和分期分类在2002年有了重大变化，本调查中的分析是根据新分类进行的。采用Kaplan - Meier方法绘制生存曲线，并使用对数秩检验评估生存差异的显著性。此外，我们还调查了1987年至2001年在日本约100家医疗机构登记的各类皮肤恶性肿瘤患者的数量，这些肿瘤不仅包括恶性黑色素瘤，还包括基底细胞癌、鳞状细胞癌、蕈样肉芽肿、光化性角化病、鲍温病和佩吉特病，并汇总了数据。
1987年至2001年对日本恶性皮肤肿瘤患者的全国性调查显示，最常见的皮肤肿瘤是基底细胞癌，其逐年增加，其次是鳞状细胞癌，然后是恶性黑色素瘤。从1987年至2001年在主要机构登记的黑色素瘤患者数据中得到以下结果。（1）各时间组黑色素瘤患者的总体10年生存率排名为：C组 > B组 > A组，不过只有C组和A组之间的差异具有统计学意义。（2）男女比例在1 : 0.97至1 : 1.14之间，女性患者的生存率高于男性患者（女性140个月生存率为70.6%，男性为60%）。（3）年龄分布评估显示，所有三组患者数量在40 - 49岁时迅速增加，并在60岁左右达到峰值。（4）足底是男性和女性黑色素瘤最常见的部位，而女性下肢黑色素瘤也较为普遍。（5）肢端雀斑样痣黑色素瘤（ALM）是所有三组中最常见的类型，每组患者中近50%为此类型。浅表扩散性黑色素瘤（SSM）患者数量随时间稳步增加，在C组中超过了结节性黑色素瘤（NM）患者数量。NM的预后最差，而SSM的预后最有利。（6）C组中I期患者的比例高于A组和B组，但II期、III期和IV期患者比例在各组之间未观察到显著差异。对于III期患者，C组的总体生存率高于A组或B组，而I期或II期患者组间生存无明显差异。对于IV期患者，C组的生存率略低于A组或B组。（7）在C组中，III A、III B和III C亚期的总体生存率排名为III A > III B > III C。（8）IV期M1a、M1b和M1c的总体生存率排名为M1a > M1b > M1c。在C组中，血清乳酸脱氢酶（LDH）水平正常的IV期患者的总体生存率高于LDH值升高的患者。（9）对一些治疗方法（预防性淋巴结清扫以及使用和不使用干扰素-β的化疗）对黑色素瘤患者生存影响的评估尚无定论，表明该领域需要更多研究。
在日本，恶性皮肤肿瘤患者数量逐年增加。晚期恶性黑色素瘤患者的预后仍然极差，但III期患者的预后有所改善。
