Cybulska-Stopa Bożena, Skoczek Marta, Ziobro Marek, Switaj Tomasz, Falkowski Sławomir, Morysiński Tadeusz, Hetnał Marcin, Cedrych Ida, Rutkowski Piotr
Department of Systemic and Generalized Malignancies, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute Cracow Branch, Poland.
Contemp Oncol (Pozn). 2012;16(6):532-45. doi: 10.5114/wo.2012.32487. Epub 2013 Jan 4.
The incidence of melanoma is increasing rapidly worldwide. Metastatic melanoma is still an incurable disease, although an era of new drugs is approaching. Current methods to predict outcomes in patients with advanced, metastatic melanoma are limited. A retrospective analysis of a contemporary large group of advanced melanomas was performed to determine clinical prognostic factors that accurately predict survival in patients with metastatic melanoma before the era of new targeted/immunological therapy.
The retrospective analysis of 427 patients with metastatic melanoma treated between 1995 and 2005 at two reference oncological centres.
The median overall survival time (OS) was 7.1 months (95% CI: 6.7-7.9) and the 1-year, 2-year and 5-year survival rates were 32.3%; 12.5%; 3.9%, respectively. The median progression-free survival time (PFS) after the first line of treatment was 3.5 months (95% CI: 3.1-3.8). There were 19.1% objective responses (CR - 6.1%, PR - 13.0%) and SD - 45.5% after the first line of therapy. The most common adverse events were anaemia, neutropenia, thrombocytopenia, nausea and vomiting. IN MULTIVARIATE ANALYSES: PS (performance status) 0-1, normal serum levels of lactate dehydrogenase (LDH) and aspartate transaminase (AspAT), older age in women, palliative surgical treatment and palliative radiotherapy, type of the first line of therapy (DTIC), and metastatic melanoma of unknown primary site were independent positive predictors for survival.
The survival rate of patients with metastatic melanoma has not changed significantly over the last years. We identified a set of independent positive predictors for OS treated with systemic therapy. DTIC still may be useful in treatment of patients in a good general condition and with normal serum levels of LDH. Because the results of treatment of metastatic melanoma are still not satisfactory, the majority of patients should be treated within prospective, randomized clinical trials.
全球范围内黑色素瘤的发病率正在迅速上升。转移性黑色素瘤仍然是一种无法治愈的疾病，尽管新药时代即将来临。目前预测晚期转移性黑色素瘤患者预后的方法有限。我们对当代一大组晚期黑色素瘤患者进行了回顾性分析，以确定在新的靶向/免疫治疗时代之前能准确预测转移性黑色素瘤患者生存情况的临床预后因素。
对1995年至2005年间在两个参考肿瘤中心接受治疗的427例转移性黑色素瘤患者进行回顾性分析。
中位总生存时间（OS）为7.1个月（95%可信区间：6.7 - 7.9），1年、2年和5年生存率分别为32.3%、12.5%、3.9%。一线治疗后的中位无进展生存时间（PFS）为3.5个月（95%可信区间：3.1 - 3.8）。一线治疗后有19.1%的客观缓解（完全缓解 - 6.1%，部分缓解 - 13.0%），疾病稳定率为45.5%。最常见的不良事件为贫血、中性粒细胞减少、血小板减少、恶心和呕吐。多因素分析：体能状态（PS）0 - 1、乳酸脱氢酶（LDH）和天冬氨酸转氨酶（AspAT）血清水平正常、老年女性、姑息性手术治疗和姑息性放疗、一线治疗类型（达卡巴嗪）以及原发部位不明的转移性黑色素瘤是生存的独立阳性预测因素。
过去几年转移性黑色素瘤患者的生存率没有显著变化。我们确定了一组接受全身治疗患者总生存的独立阳性预测因素。达卡巴嗪对于一般状况良好且LDH血清水平正常的患者治疗仍可能有用。由于转移性黑色素瘤的治疗结果仍不令人满意，大多数患者应在前瞻性随机临床试验中接受治疗。
