Burton Alison L, Gilbert Juliana, Farmer Russell W, Stromberg Arnold J, Hagendoorn Lee, Ross Merrick I, Martin Robert C G, McMasters Kelly M, Scoggins Charles R, Callender Glenda G
Department of Surgery, University of Louisville, Louisville, Kentucky, USA.
Am Surg. 2011 Aug;77(8):1009-13.
Controversy exists regarding the prognostic implications of regression in patients with cutaneous melanoma. Some consider regression to be an indication for sentinel lymph node (SLN) biopsy because regression may result in underestimation of the true Breslow thickness. Other data support regression as a favorable prognostic indicator, representing immune system recognition of the primary tumor. This analysis was performed to determine whether regression predicts nodal metastasis, disease-free survival (DFS), or overall survival (OS). Post hoc analysis was performed of a multicenter prospective randomized trial that included patients aged 18 to 70 years with cutaneous melanomas 1 mm or greater Breslow thickness. All patients underwent SLN biopsy; those with tumor-positive SLN underwent completion lymphadenectomy. Kaplan-Meier analysis of survival, univariate analysis, and multivariate analysis were performed. A total of 2220 patients (261 with regression; 1959 without regression) were included in this analysis with a median follow-up of 68 months. Patients with regression were more likely to be male, older than 50 years old, and have lower median Breslow thickness, superficial spreading histologic subtype, and a nonextremity anatomic location (P < 0.05 in all cases). Regression was not significantly associated with Clark level, ulceration, lymphovascular invasion, number of SLNs removed, or SLN metastasis. On multivariate analysis, factors independently predictive of DFS included Breslow thickness, ulceration, and SLN status (P < 0.05 in all cases); the same factors along with age, gender, and anatomic tumor location were significantly associated with OS (P < 0.05 in all cases). Regression was not significantly associated with DFS (risk ratio [RR], 0.94; 95% confidence interval [CI], 0.67-1.27; P = 0.68) or OS (RR, 1.01; 95% CI, 0.76-1.32; P = 0.93). These data suggest that regression is not a significant prognostic factor for patients with cutaneous melanoma and should not be used to guide clinical decision-making for such patients.
关于皮肤黑色素瘤患者消退的预后意义存在争议。一些人认为消退是前哨淋巴结（SLN）活检的指征，因为消退可能导致对真正的 Breslow 厚度估计不足。其他数据支持消退是一个有利的预后指标，代表免疫系统对原发性肿瘤的识别。进行这项分析是为了确定消退是否能预测淋巴结转移、无病生存期（DFS）或总生存期（OS）。对一项多中心前瞻性随机试验进行了事后分析，该试验纳入了年龄在 18 至 70 岁之间、Breslow 厚度为 1 毫米或更大的皮肤黑色素瘤患者。所有患者均接受了 SLN 活检；SLN 肿瘤阳性的患者接受了根治性淋巴结清扫术。进行了生存的 Kaplan-Meier 分析、单因素分析和多因素分析。本分析共纳入 2220 例患者（261 例有消退；1959 例无消退），中位随访时间为 68 个月。有消退的患者更可能为男性，年龄超过 50 岁，且 Breslow 厚度中位数较低，组织学亚型为浅表扩散型，解剖部位不在四肢（所有情况 P < 0.05）。消退与 Clark 分级、溃疡、淋巴管侵犯、切除的 SLN 数量或 SLN 转移均无显著相关性。在多因素分析中，独立预测 DFS 的因素包括 Breslow 厚度、溃疡和 SLN 状态（所有情况 P < 0.05）；相同的因素以及年龄、性别和肿瘤解剖部位与 OS 显著相关（所有情况 P < 0.05）。消退与 DFS（风险比[RR]，0.94；95%置信区间[CI]，0.67 - 1.27；P = 0.68）或 OS（RR，1.01；95%CI，0.76 - 1.32；P = 0.93）均无显著相关性。这些数据表明，消退不是皮肤黑色素瘤患者的重要预后因素，不应以此来指导此类患者临床决策的制定。
