Berger Adam C, Ollila David W, Christopher Adrienne, Kairys John C, Mastrangelo Michael J, Feeney Kendra, Dabbish Nooreen, Leiby Benjamin, Frank Jill A, Stitzenberg Karyn B, Meyers Michael O
Department of Surgery, Thomas Jefferson University, Philadelphia, PA.
Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA.
J Am Coll Surg. 2017 Apr;224(4):652-659. doi: 10.1016/j.jamcollsurg.2016.12.038. Epub 2017 Feb 8.
Patients with stage II melanoma have a considerable risk for recurrence. Current guidelines are imprecise as to optimal follow-up. We hypothesized that by examining recurrence patterns, we could help to better inform guidelines.
We queried IRB-approved melanoma databases of Thomas Jefferson University and University of North Carolina, identifying 581 patients with stage II melanoma between 1996 and 2015 with at least 1 year of follow-up. Data included location of first recurrence and how recurrence was detected (ie patient symptom, physician examination, or routine surveillance imaging). Cox regression with backward elimination was used for multivariable analysis.
One hundred and seventy-one patients had a recurrence (29.4%), the incidence increased considerably by stage sub-group. Significant predictors of recurrence included male sex (p = 0.003), ulceration (p = 0.03), and stage (p < 0.001). On multivariable analysis, male sex and stage continued to be significant (p < 0.01). For overall survival, regression, ulceration, stage, and age were significant predictors of survival. Stage, regression, and age remained significant by multivariable analysis. Patient symptoms were the most frequent mode of detection (40%), followed by physician examination (30%) and surveillance imaging (26%)-this did not differ significantly by stage. Regional nodes were the most common site of recurrence (30%), followed by lung (27%) and in-transit (18%).
The majority of recurrences in stage II melanoma are detected by patients and their physicians and rarely by routine imaging. As such, clinical follow-up and patient education are critical factors in detection of recurrence. With the prevalence of regional nodal recurrences, ultrasound might prove to be an important strategy in early recurrence detection.
II期黑色素瘤患者有相当高的复发风险。目前的指南对于最佳随访方案并不明确。我们推测，通过研究复发模式，我们可以为指南提供更完善的信息。
我们查询了托马斯·杰斐逊大学和北卡罗来纳大学经机构审查委员会批准的黑色素瘤数据库，确定了1996年至2015年间581例II期黑色素瘤患者，这些患者至少随访了1年。数据包括首次复发的部位以及复发的检测方式（即患者症状、医生检查或常规监测成像）。采用逐步回归的Cox回归进行多变量分析。
171例患者出现复发（29.4%），复发率在分期亚组中有显著增加。复发的显著预测因素包括男性（p = 0.003）、溃疡（p = 0.03）和分期（p < 0.001）。在多变量分析中，男性和分期仍然具有显著性（p < 0.01）。对于总生存期，回归、溃疡、分期和年龄是生存的显著预测因素。分期、回归和年龄在多变量分析中仍然具有显著性。患者症状是最常见的检测方式（40%），其次是医生检查（30%）和监测成像（26%），不同分期之间无显著差异。区域淋巴结是最常见的复发部位（30%），其次是肺部（27%）和移行转移（18%）。
II期黑色素瘤的大多数复发是由患者及其医生发现的，很少通过常规成像检测到。因此，临床随访和患者教育是复发检测的关键因素。鉴于区域淋巴结复发的普遍性，超声可能是早期复发检测的重要策略。
