Coit D, Sauven P, Brennan M
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Arch Surg. 1990 Mar;125(3):322-6. doi: 10.1001/archsurg.1990.01410150044009.
The records of 129 patients with thick cutaneous melanoma of the trunk or extremity treated at Memorial Sloan-Kettering Cancer Center, New York, NY, between 1974 and 1984 were reviewed with the aim of defining prognostic variables. All primary lesions invaded subcutaneous fat, were Clark level V, or of a Breslow thickness of 4.0 mm or greater. Treatment in all cases was by wide excision with or without split-thickness skin graft; all patients underwent regional lymph node dissection. Overall survival rate for the group was 47% at 5 years and 36% at 10 years. Factors independently predictive of survival were pathologic negative nodes (71% at 5 years compared with 28% for pathologic positive nodes) and extremity site (58% at 5 years compared with 33% for truncal site). Patients with node-negative thick cutaneous melanoma of the extremity had a 5-year survival rate of 82%. Patients with node-positive truncal thick cutaneous melanoma had a 5-year survival rate of only 8%. There was no difference between the 5-year survival rate of patients with node-negative truncal thick cutaneous melanoma, 52%, and patients with node-positive thick cutaneous melanoma of the extremity, 42%. Nearly half of the patients with thick cutaneous melanoma of the extremity and trunk present with locoregional disease, at a stage when an aggressive surgical approach is warranted. Prognostic variables of pathologic nodal status and site identify patients at risk for early systemic failure.
对1974年至1984年间在纽约市纪念斯隆-凯特琳癌症中心接受治疗的129例躯干或四肢厚皮型黑色素瘤患者的记录进行了回顾，目的是确定预后变量。所有原发性病变均侵犯皮下脂肪，为克拉克V级，或 Breslow厚度为4.0毫米或更大。所有病例均采用广泛切除，伴或不伴分层皮片移植；所有患者均接受区域淋巴结清扫。该组患者的5年总生存率为47%，10年为36%。独立预测生存的因素是病理检查淋巴结阴性（5年生存率为71%，而病理检查淋巴结阳性为28%）和四肢部位（5年生存率为58%，而躯干部位为33%）。四肢淋巴结阴性的厚皮型黑色素瘤患者的5年生存率为82%。躯干淋巴结阳性的厚皮型黑色素瘤患者的5年生存率仅为8%。躯干淋巴结阴性的厚皮型黑色素瘤患者的5年生存率（52%）与四肢淋巴结阳性的厚皮型黑色素瘤患者的5年生存率（42%）之间没有差异。近一半的躯干和四肢厚皮型黑色素瘤患者出现局部区域疾病，处于需要积极手术治疗的阶段。病理淋巴结状态和部位的预后变量可识别有早期全身衰竭风险的患者。
