Speijers M J, Bastiaannet E, Sloot S, Suurmeijer A J H, Hoekstra H J
Division of Surgical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Ann Surg Oncol. 2015 Sep;22(9):2978-87. doi: 10.1245/s10434-014-4349-3. Epub 2015 Jan 21.
This study aimed to investigate the predictive value of the tumor mitotic rate per mm(2) (TMR) for sentinel lymph node (SLN) status and survival in intermediate and thick cutaneous melanoma.
Patients treated for stage I and II melanoma with wide local excision and SLN biopsy between May 1995 and May 2013 were analyzed. In case of insufficient data regarding TMR, pathology slides were reanalyzed. Prognostic factors for SLN status and survival were analyzed with the emphasis on TMR, which was analyzed as a continuous variable, dichotomized (median value) and categorized by two methods.
The study analyzed 453 patients with complete TMR data. The median Breslow thickness was 2.20 mm, and 31.8 % of patients had tumor-positive sentinel lymph node biopsies (SLNBs). In the univariate analysis, TMR was associated with tumor-positive SLNB. This association was not significant in the multivariate analysis. Breslow thickness, primary tumor location on trunk and legs, and younger age were associated with tumor-positive SNLB. At a median follow-up of 47 months, 119 patients (26.3 %) had recurrent disease, and 92 (20.3 %) had died of melanoma. In the univariate analysis, TMR could be established as a significant prognostic factor for disease-free and disease-specific survival, but not in the multivariate analyses. Breslow thickness, ulcerated melanoma, and tumor-positive SLNB were significant prognostic factors for survival.
The study was unable to establish TMR as an independent prognostic factor associated with the presence of SLN metastasis. Regarding survival, increasing TMR showed a strong association with decreased survival in the univariate analysis, but this association was rendered nonsignificant by the importance of Breslow thickness and ulceration status in the multivariate model.
本研究旨在探讨每平方毫米肿瘤有丝分裂率（TMR）对中度和厚皮黑色素瘤前哨淋巴结（SLN）状态及生存的预测价值。
对1995年5月至2013年5月期间接受I期和II期黑色素瘤广泛局部切除及SLN活检治疗的患者进行分析。若TMR数据不足，则重新分析病理切片。重点分析TMR作为连续变量、二分法（中位数）以及两种分类方法时，SLN状态和生存的预后因素。
本研究分析了453例有完整TMR数据的患者。Breslow厚度中位数为2.20毫米，31.8%的患者前哨淋巴结活检（SLNB）结果为肿瘤阳性。单因素分析中，TMR与肿瘤阳性SLNB相关。多因素分析中，这种相关性不显著。Breslow厚度、躯干和腿部的原发肿瘤位置以及较年轻的年龄与肿瘤阳性SLNB相关。中位随访47个月时，119例患者（26.3%）出现疾病复发，92例（20.3%）死于黑色素瘤。单因素分析中，TMR可被确定为无病生存和疾病特异性生存的重要预后因素，但多因素分析中并非如此。Breslow厚度、溃疡型黑色素瘤和肿瘤阳性SLNB是生存的重要预后因素。
本研究无法将TMR确立为与SLN转移存在相关的独立预后因素。关于生存，单因素分析中TMR升高与生存降低密切相关，但在多因素模型中，由于Breslow厚度和溃疡状态的重要性，这种相关性不显著。
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