Department of Pediatric Surgery, The University of Texas Medical School at Houston, Houston, TX, USA.
Ann Surg. 2011 Jun;253(6):1211-5. doi: 10.1097/SLA.0b013e318217e852.
The aim of this study was to determine the influence of age on outcome in pediatric melanoma patients and to identify factors associated with positive lymph node status in this population.
A retrospective review of a prospective pediatric melanoma database, using sentinel lymph node biopsy (SLNB), from 1992 to 2006, identified 109 patients with the primary diagnosis of melanoma. Patient age was dichotomized as prepubescent (<10 years of age) and adolescent (≥10-18 years of age). Factors investigated included patient race, sex, and lymph node status and tumor thickness, Spitzoid or Non-Spitzoid histology, radial growth phase, and vascular invasion. The Fisher's exact test was used to compare patient groups. Time-to-event analysis was performed using the Kaplan-Meier method.
There were 25 prepubescent and 84 adolescent patients. Prepubescent patients were more often non-White, had greater tumor thickness, more spitzoid tumors and more vascular invasion. Ten-year overall survival (OS) was 89% and 10-year event-free survival (EFS) was 73%. Among 57 patients who had an SLNB, prepubertal patients had a higher percentage of sentinel lymph node positivity. The odds having a positive SLNB decreased by 13% each year with increasing age. Patients with a tumor thickness ≥2.01 mm had higher odds of having a positive lymph node compared with those patients with a tumor thickness ≤1.0.
This is the largest known study of prepubertal melanoma patients. Although OS and EFS did not differ by age groups, younger ages showed increased risk of lymph node metastasis and thicker tumors. This suggests that the younger pediatric patients may have a disease that differs biologically from that of the older pediatric patients.
本研究旨在确定年龄对儿科黑色素瘤患者预后的影响，并确定该人群中与阳性淋巴结状态相关的因素。
回顾性分析了 1992 年至 2006 年期间使用前哨淋巴结活检（SLNB）的前瞻性儿科黑色素瘤数据库，共确定了 109 例黑色素瘤初诊患者。将患者年龄分为青春期前（<10 岁）和青春期（≥10-18 岁）。调查的因素包括患者种族、性别、淋巴结状态和肿瘤厚度、Spitz 样或非 Spitz 样组织学、放射状生长阶段和血管侵犯。使用 Fisher 精确检验比较患者组。使用 Kaplan-Meier 方法进行生存时间分析。
有 25 例青春期前和 84 例青春期患者。青春期前患者更常为非白人，肿瘤厚度更大，Spitz 样肿瘤更多，血管侵犯更多。10 年总生存率（OS）为 89%，10 年无事件生存率（EFS）为 73%。在 57 例进行了 SLNB 的患者中，青春期前患者的前哨淋巴结阳性率更高。随着年龄的增加，每年发生阳性 SLNB 的几率降低 13%。肿瘤厚度≥2.01mm 的患者发生淋巴结阳性的几率高于肿瘤厚度≤1.0mm 的患者。
这是目前已知的最大规模的青春期前黑色素瘤患者研究。尽管 OS 和 EFS 不因年龄组而异，但年龄较小的患者发生淋巴结转移和肿瘤厚度增加的风险更高。这表明年轻的儿科患者的疾病在生物学上可能与年长的儿科患者不同。
