Slingluff C L, Reintgen D S, Vollmer R T, Seigler H F
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
Ann Surg. 1990 May;211(5):552-7; discussion 558-9. doi: 10.1097/00000658-199005000-00005.
Melanoma is often diagnosed in young adults, a significant proportion of whom are women of child-bearing age. The prognosis of women diagnosed with melanoma during a pregnancy continues to be debated. One hundred patients, ages 19 to 40 years, have been identified who were pregnant at the time of diagnosis of their melanoma. All were treated with local excision. Sixteen per cent underwent elective lymph node dissections. Immunotherapy was administered to 83% of patients. Mean follow-up was 6.8 years from the date of diagnosis. The patients were compared to an age-matched group of 86 women who were not pregnant at the time of diagnosis. Overall mortality during the follow-up period was 25% in the pregnant group and 23% in the control group. Among the pregnant group, there was an increased incidence of lymph node metastases during the follow-up period (39% versus 26%, p = 0.053). Among stage I patients, there was a significantly shorter DFI for the pregnant group (p = 0.039), with 50% of pregnant patients and 67% of control patients free of disease at 10 years. Similarly, among stage 1 patients, the time to development of lymph node metastases was shorter in the pregnant group (p = 0.021). Multivariate analysis demonstrated that pregnancy at diagnosis was significantly associated with the development of metastatic disease (p = 0.008), when controlling for tumor site, thickness, and Clark level. Patients who developed melanoma during pregnancy did not, however, have a significant decrease in survival.
黑色素瘤常被诊断于年轻成年人中，其中很大一部分是育龄期女性。孕期被诊断为黑色素瘤的女性患者的预后仍存在争议。已确定100名年龄在19至40岁之间的患者，她们在黑色素瘤诊断时处于孕期。所有患者均接受了局部切除术。16%的患者接受了选择性淋巴结清扫术。83%的患者接受了免疫治疗。自诊断之日起的平均随访时间为6.8年。将这些患者与86名年龄匹配的、诊断时未怀孕的女性组成的对照组进行比较。随访期间，怀孕组的总死亡率为25%，对照组为23%。在怀孕组中，随访期间淋巴结转移的发生率有所增加（39%对26%，p = 0.053）。在I期患者中，怀孕组的无病生存期明显较短（p = 0.039），10年时50%的怀孕患者和67%的对照患者无疾病。同样，在I期患者中，怀孕组发生淋巴结转移的时间较短（p = 0.021）。多变量分析表明，在控制肿瘤部位、厚度和克拉克分级后，诊断时怀孕与转移性疾病的发生显著相关（p = 0.008）。然而，孕期发生黑色素瘤的患者的生存率并没有显著下降。
