Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA.
Cancer. 2012 Sep 1;118(17):4184-92. doi: 10.1002/cncr.27407. Epub 2012 Jan 13.
In patients with multiple primary melanomas (MPM), mean tumor thickness tends to decrease from the first melanoma to the second melanoma, and prognosis may be improved compared with the prognosis for patients who have a single primary melanoma (SPM). In this study, the authors compared the clinicopathologic features of patients with MPM and SPM to better characterize the differences between these 2 groups and to determine whether or not there is an inherent difference in tumor aggression.
In total, 788 patients with melanoma who were enrolled prospectively in the Interdisciplinary Melanoma Cooperative Group database from 2002 to 2008 were studied. Patients with SPM and with MPM were compared with regard to clinical and primary melanoma characteristics.
Of 788 patients with melanoma, 61 patients (7.7%) had 2 or more primary melanomas. The incidence of developing a second primary melanoma 1 year and 5 years after initial melanoma diagnosis was 4.1% and 8.7%, respectively, and most of the risk accumulated within the first year. The incidence of MPM was greater in patients aged ≥60 years than in those aged ≤60 years. The absence or presence of mitosis and other tumor characteristics did not differ significantly between patients with SPM and patients with MPM (P = .61).
No difference was observed in the presence or absence of mitoses, a marker of tumor proliferation, in SPM and MPM. Because it has been demonstrated that the presence of mitosis is a powerful prognostic marker, the current findings suggested that the tumors behave similarly in patients with SPM and patients with MPM. The authors concluded that differences in tumor thickness and prognosis between SPM and MPM more likely are caused by factors other than tumor biology, such as increased surveillance.
在患有多发原发性黑素瘤（MPM）的患者中，从第一个黑素瘤到第二个黑素瘤，平均肿瘤厚度往往会降低，与患有单一原发性黑素瘤（SPM）的患者相比，预后可能会改善。在这项研究中，作者比较了 MPM 和 SPM 患者的临床病理特征，以便更好地描述这两组患者之间的差异，并确定肿瘤侵袭性是否存在固有差异。
本研究共纳入了 2002 年至 2008 年期间前瞻性纳入跨学科黑素瘤合作组数据库的 788 例黑素瘤患者。比较了 SPM 和 MPM 患者的临床和原发性黑素瘤特征。
在 788 例黑素瘤患者中，有 61 例（7.7%）有 2 个或更多的原发性黑素瘤。在初始黑素瘤诊断后 1 年和 5 年时，第二原发性黑素瘤的发生率分别为 4.1%和 8.7%，且大部分风险在第 1 年内累积。在年龄≥60 岁的患者中，MPM 的发生率大于年龄≤60 岁的患者。SPM 和 MPM 患者之间，无有丝分裂和其他肿瘤特征的存在与否差异无统计学意义（P=0.61）。
在 SPM 和 MPM 中，有丝分裂的存在与否，作为肿瘤增殖的标志物，没有观察到差异。由于已经证明有丝分裂的存在是一个强大的预后标志物，因此目前的研究结果表明，在 SPM 和 MPM 患者中，肿瘤的行为相似。作者得出结论，SPM 和 MPM 之间肿瘤厚度和预后的差异更可能是由肿瘤生物学以外的因素引起的，例如增加监测。
