Microvascular Research Laboratories, Bristol Heart Institute, Department of Physiology and Pharmacology, University of Bristol, Bristol, UK.
BMC Cancer. 2010 May 17;10:208. doi: 10.1186/1471-2407-10-208.
Melanoma usually presents as an initial skin lesion without evidence of metastasis. A significant proportion of patients develop subsequent local, regional or distant metastasis, sometimes many years after the initial lesion was removed. The current most effective staging method to identify early regional metastasis is sentinel lymph node biopsy (SLNB), which is invasive, not without morbidity and, while improving staging, may not improve overall survival. Lymphatic density, Breslow's thickness and the presence or absence of lymphatic invasion combined has been proposed to be a prognostic index of metastasis, by Shields et al in a patient group.
Here we undertook a retrospective analysis of 102 malignant melanomas from patients with more than five years follow-up to evaluate the Shields' index and compare with existing indicators.
The Shields' index accurately predicted outcome in 90% of patients with metastases and 84% without metastases. For these, the Shields index was more predictive than thickness or lymphatic density. Alternate lymphatic measurement (hot spot analysis) was also effective when combined into the Shields index in a cohort of 24 patients.
These results show the Shields index, a non-invasive analysis based on immunohistochemistry of lymphatics surrounding primary lesions that can accurately predict outcome, is a simple, useful prognostic tool in malignant melanoma.
黑色素瘤通常表现为初始皮肤病变，无转移证据。相当一部分患者会随后发生局部、区域或远处转移，有时在初始病变切除后多年才会发生。目前最有效的分期方法是通过前哨淋巴结活检（SLNB）来识别早期区域转移，该方法具有侵袭性，并非没有发病率，虽然可以改善分期，但可能不会改善整体生存率。Shields 等人提出，淋巴管密度、Breslow 厚度以及有无淋巴管浸润的组合可以作为转移的预后指标，这在一组患者中得到了验证。
在这里，我们对 102 例随访时间超过 5 年的恶性黑色素瘤患者进行了回顾性分析，以评估 Shields 指数，并与现有指标进行比较。
Shields 指数在 90%有转移的患者和 84%无转移的患者中准确预测了结果。对于这些患者，Shields 指数比厚度或淋巴管密度更具预测性。在 24 例患者的队列中，将替代的淋巴管测量（热点分析）结合到 Shields 指数中也同样有效。
这些结果表明，Shields 指数是一种基于原发性病变周围淋巴管的免疫组织化学的非侵入性分析，可以准确预测结果，是恶性黑色素瘤中一种简单、有用的预后工具。
