The New York University Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, NY 10016, USA.
Oncology. 2011;80(3-4):181-7. doi: 10.1159/000328518. Epub 2011 Jun 24.
Previous melanoma studies evaluating prognostic factors of survival at recurrence have focused on primary tumor characteristics and clinical variables at first recurrence. We examined the prognostic relevance of recurrent tumor proliferation.
114 melanoma patients with available recurrent tissues who were prospectively enrolled at New York University Medical Center were studied. Standard of care prognostic variables (e.g. stage at initial diagnosis and lactate dehydrogenase level) and recurrent tissue expression of proliferative marker Ki-67 were evaluated for their association with overall survival.
High Ki-67 expression was observed in 57 (50%) of the 114 recurrent melanomas. On univariate analysis, the median overall survival of patients whose recurrent tumors overexpressed Ki-67 was significantly shorter than that of patients whose recurrent tumors had low Ki-67 expression (3.6 vs. 9.5 years, p = 0.03). On multivariate analysis, a high proliferative index of the recurrent melanoma remained an independent predictor of worse overall survival, controlling for stage at initial diagnosis, disease-free survival, and stage at first recurrence [HR = 2.09 (95% CI 1.24-3.54), p = 0.006].
Our results demonstrate the prognostic relevance of tumor proliferation in recurrent melanoma patients. Data also support restratification of risk assessment upon recurrence that considers tumor biology in addition to clinical variables evaluated as part of the standard of care.
既往评估复发时生存预后因素的黑色素瘤研究主要集中在原发性肿瘤特征和首次复发时的临床变量上。我们研究了复发性肿瘤增殖的预后相关性。
对纽约大学医学中心前瞻性纳入的 114 例具有可获取复发性组织的黑色素瘤患者进行了研究。评估了标准治疗预后变量（例如初始诊断时的分期和乳酸脱氢酶水平）和复发性组织中增殖标志物 Ki-67 的表达与总生存的相关性。
在 114 例复发性黑色素瘤中，观察到 57 例（50%）Ki-67 高表达。单因素分析显示，Ki-67 过表达的复发性肿瘤患者的中位总生存期明显短于 Ki-67 低表达的患者（3.6 年 vs. 9.5 年，p = 0.03）。多因素分析显示，复发性黑色素瘤的高增殖指数仍然是总生存较差的独立预测因素，控制了初始诊断时的分期、无病生存期和首次复发时的分期[风险比（HR）= 2.09（95%置信区间 1.24-3.54），p = 0.006]。
我们的研究结果表明，肿瘤增殖在复发性黑色素瘤患者中具有预后相关性。数据还支持在复发时进行风险评估的重新分层，除了标准治疗中评估的临床变量外，还考虑肿瘤生物学。
