皮肤促结缔组织增生性黑色素瘤的预后因素：252 例患者研究。

Prognostic factors in cutaneous desmoplastic melanoma: a study of 252 patients.

机构信息

Diagnostic Oncology and Tissue Pathology, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia.

出版信息

Cancer. 2010 Sep 1;116(17):4130-8. doi: 10.1002/cncr.25148.

DOI:10.1002/cncr.25148

PMID:20564101

Abstract

BACKGROUND

Desmoplastic melanoma (DM) is a rare subtype of melanoma that is characterized by malignant spindle cells separated by prominent, fibrocollagenous stroma. Primary melanomas either may be entirely desmoplastic or almost entirely desmoplastic (pure DM [pDM]) or may exhibit a desmoplastic component admixed with a nondesmoplastic component (combined DM [cDM]).

METHODS

Patients who were diagnosed between 1993 and 2007 at a single institution with clinically localized, primary cutaneous melanoma (PCM) that contained a desmoplastic component and who underwent sentinel lymph node (SLN) biopsy were identified. Clinical and pathologic features of the primary tumors were correlated with DM type, SLN status, and patient outcome.

RESULTS

Two hundred fifty-two patients (167 men, 85 women) were identified (median age, 61 years). The median tumor thickness was 2.0 mm. One hundred twenty-three patients (48.8%) had pDM, and 129 patients (51.2%) had cDM. Overall, 17 patients (6.7%) had positive SLN status, including 12 patients with cDM and 5 patients with pDM. Because of the low SLN-positive rate, a statistically significant difference in SLN status between patients with cDM (8.5%) and patients with pDM (4.9%; P = .25) could not be demonstrated. Older patient age, being a man, positive SLN status, and increasing tumor thickness were associated significantly with poorer disease-free survival (P < .05), although only the latter 2 variables were independently predictive. In addition, cDM type (P = .017) was associated significantly and independently with a shorter time to recurrence.

CONCLUSIONS

In this largest study to date of patients with DM who underwent SLN biopsy, the SLN-positive rate in patients with DM was lower than that in patients with conventional melanoma. The results indicated that DM type is associated significantly and independently with the time to recurrence and should be evaluated routinely in all patients with PCM. Cancer 2010. (c) 2010 American Cancer Society.

摘要

背景

促结缔组织增生性黑色素瘤（DM）是一种罕见的黑色素瘤亚型，其特征为恶性梭形细胞被明显的纤维胶原基质分隔。原发性黑色素瘤可能完全是促结缔组织增生性的（纯 DM [pDM]），也可能几乎完全是促结缔组织增生性的（纯 DM [pDM]），或者可能表现出促结缔组织增生性成分与非促结缔组织增生性成分混合的成分（混合 DM [cDM]）。

方法

在一家机构诊断为 1993 年至 2007 年间具有临床局限性、原发性皮肤黑色素瘤（PCM）且含有促结缔组织增生性成分的患者，并接受了前哨淋巴结（SLN）活检。对原发肿瘤的临床和病理特征与 DM 类型、SLN 状态和患者预后进行了相关性分析。

结果

共确定了 252 名患者（167 名男性，85 名女性）（中位年龄 61 岁）。中位肿瘤厚度为 2.0 毫米。123 名患者（48.8%）为 pDM，129 名患者（51.2%）为 cDM。总体而言，17 名患者（6.7%）的 SLN 状态呈阳性，其中 12 名患者为 cDM，5 名患者为 pDM。由于 SLN 阳性率较低，因此不能证明 cDM 患者（8.5%）与 pDM 患者（4.9%；P =.25）之间的 SLN 状态存在统计学显著差异。老年患者年龄、男性、SLN 阳性状态和肿瘤厚度增加与无病生存率显著相关（P <.05），尽管只有后两个变量具有独立预测性。此外，cDM 类型（P =.017）与复发时间显著且独立相关。