Queensland Institute of Medical Research, Cancer and Population Studies group, Brisbane, QLD, Australia.
Int J Cancer. 2013 Dec 15;133(12):3000-7. doi: 10.1002/ijc.28318. Epub 2013 Aug 5.
The outcome of patients with palpable melanoma metastases in lymph nodes in the presence (metastatic melanoma of known primary site, MKP) or absence (metastatic melanoma of unknown primary site, MUP) of an identifiable primary tumour remains controversial. Some of the previous studies contained large case series that included historical patients. We aimed to compare outcomes of those with MUPs versus MKPs with palpable lymph node invasion, after staging with modern imaging technology. Aprospective study of patients from a single tertiary institution who were undergoing lymph node dissection for palpable metastatic melanoma between 2000 and 2011 was conducted. All patients were ascertained by computerised tomography scanning and most diagnosed after 2004 had positron emission tomography scanning also. Clinicopathological details about the primary melanoma and lymph node dissections were gathered. Factors associated with recurrence and melanoma-specific mortality in those with MKP and with MUP were assessed using univariate and multivariate analyses. Out of 485 patients studied, 82 had MUP and 403 had MKP. Patients were followed up for a median of 17.4 and 19.0 months, for MKP and MUP, respectively. Five-year adjusted melanoma-specific survival was 58% for MUPs versus 49% for MKPs and was not significantly different between the two groups (adjusted Cox proportional Hazard ratio = 0.88 95% confidence interval [0.58, 1.33] p = 0.54). Previously established prognostic factors such as number of positive nodes and extracapsular extension were confirmed in both sets of patients. We conclude that among melanoma patients presenting with clinically detectable nodes, when accurately staged, those without an identifiable primary lesion have similar outcomes to patients with MKP.
有可识别原发性肿瘤（已知原发性黑色素瘤转移，MKP）或无（不明原发性黑色素瘤转移，MUP）的可触及淋巴结转移的患者的预后仍然存在争议。一些先前的研究包含了包含历史患者的大型病例系列。我们旨在比较具有 MUP 和 MKP 的患者在使用现代成像技术进行分期后，具有可触及淋巴结浸润的患者的结果。对 2000 年至 2011 年间在一家三级医疗机构因可触及转移性黑色素瘤而行淋巴结清扫术的患者进行了一项前瞻性研究。所有患者均通过计算机断层扫描确定，并且大多数在 2004 年后诊断出的患者还进行了正电子发射断层扫描。收集了原发性黑色素瘤和淋巴结清扫术的临床病理详细信息。使用单变量和多变量分析评估了具有 MKP 和 MUP 的患者中与复发和黑色素瘤特异性死亡率相关的因素。在研究的 485 名患者中，82 名患有 MUP，403 名患有 MKP。MKP 和 MUP 患者的中位随访时间分别为 17.4 个月和 19.0 个月。MUP 的 5 年调整后的黑色素瘤特异性生存率为 58％，MKP 为 49％，两组之间无显着差异（调整后的 Cox 比例风险比= 0.88 95％置信区间[0.58，1.33] p = 0.54）。在两组患者中均证实了先前确定的预后因素，例如阳性淋巴结的数量和囊外扩展。我们得出结论，在出现临床可检测淋巴结的黑色素瘤患者中，当准确分期时，无明确原发性病变的患者与 MKP 患者的结局相似。
