Cananzi Ferdinando C M, Dalgleish Angus, Mudan Satvinder
Department of Surgery, The Royal Marsden, Fulham Road, London, SW3 6JJ, UK,
World J Surg. 2014 Jun;38(6):1542-50. doi: 10.1007/s00268-013-2418-6.
The aims of this study were to evaluate the role of surgery in the management of patients with intraabdominal metastases from melanoma and to investigate the neutrophil to lymphocyte ratio (NLR) as prognostic factor in this group of patients.
Altogether, 44 patients who underwent surgery for Intraabdominal metastases from melanoma with curative, cytoreductive, or palliative intent were analyzed.
There were 77 intraabdominal organ resections performed during the 44 operations. R0 resection was achieved in 19 (43 %) cases. Factors associated with R0 resection were an absence of extra-abdominal metastases, low serum lactate dehydrogenase, involvement of fewer than three sites, and the presence of fewer than three metastatic lesions. The 1-, 3-, and 5-year overall survival rates were, respectively, 79, 66, and 44 % in the curative intent group; 36, 18, and 9 % in the cytoreduction group; and 21, 0 and 0 % in the palliation group (curative intent vs. cytoreduction vs. palliation p < 0.001). By Cox's multivariate analysis, the independent prognostic factors were time from excision of primary melanoma to the diagnosis of intraabdominal metastases, NLR, and residual disease after surgery.
Our results confirm the usefulness of major surgical interventions as reported in previous studies. We reviewed recent evidence that immunologic phenomena may explain the unexpectedly good response rate in patients with advanced disease. The simple estimation of the NLR has been advocated as a prognostic marker for several cancers. We show that it is likewise useful in metastatic melanoma. We stress the need for developing additional immunologic markers.
本研究旨在评估手术在黑色素瘤腹内转移患者管理中的作用，并研究中性粒细胞与淋巴细胞比值（NLR）作为该组患者的预后因素。
共分析了44例因黑色素瘤腹内转移而接受手术治疗的患者，手术目的为根治性、减瘤性或姑息性。
44例手术共进行了77次腹内器官切除术。19例（43%）实现了R0切除。与R0切除相关的因素包括无腹外转移、血清乳酸脱氢酶水平低、受累部位少于三个以及转移灶少于三个。根治性手术组的1年、3年和5年总生存率分别为79%、66%和44%；减瘤手术组分别为36%、18%和9%；姑息手术组分别为21%、0%和0%（根治性手术组与减瘤手术组与姑息手术组，p<0.001）。通过Cox多因素分析，独立预后因素为从原发性黑色素瘤切除到腹内转移诊断的时间、NLR以及术后残留疾病。
我们的结果证实了先前研究报道的主要手术干预的有效性。我们回顾了近期证据，表明免疫现象可能解释晚期疾病患者出人意料的良好反应率。简单估算NLR已被提倡作为几种癌症的预后标志物。我们表明它在转移性黑色素瘤中同样有用。我们强调需要开发更多的免疫标志物。
