白种人手足部黑色素瘤组织学亚型的预后作用

Prognostic role of the histological subtype of melanoma on the hands and feet in Caucasians.

作者信息

Carrera Cristina, Gual Adrià, Díaz Alba, Puig-Butillé Joan A, Noguès Susanna, Vilalta Antonio, Conill Carlos, Rull Ramón, Vilana Ramon, Arguis Pedro, Vidal-Sicart Sergi, Alós Llucia, Palou Josep, Castel Teresa, Malvehy Josep, Puig Susana

机构信息

aMelanoma Unit, Department of Dermatology bMelanoma Unit, Department of Pathology cBiochemical and Molecular Genetics Service, Melanoma Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) dRadiotherapeutic Oncology Service, Melanoma Unit eGeneral Surgery Service, Melanoma Unit fImaging Diagnostic Center, CDI (Radiology and Nuclear Medicine Services), Melanoma Unit, Hospital Clinic gBiomedical Research Center for Rare Diseases, CIBERER. Insituto de Salud Carlos III hMedicine Department, University of Barcelona, Barcelona, Spain.

出版信息

Melanoma Res. 2017 Aug;27(4):315-320. doi: 10.1097/CMR.0000000000000340.

DOI:10.1097/CMR.0000000000000340

PMID:28296711

Abstract

Acral melanoma (AM) is associated with a poor prognosis in part because of delayed diagnosis, but probably also because of other intrinsic characteristics of location. The aim of this study was to review the specific characteristics and outcome of AM in Caucasians. This was a cross-sectional retrospective clinical-pathological study of 274 patients identified with AM in the database of a referral unit in Europe from 1986 to 2010. The mean age of the patients was 56.6 (SD 17.7) years. 269 cases could be histologically classified and included in the study. In all, 222 (82.5%) were located on feet. According to melanoma subtype, 165 (61.3%) were acral lentiginous melanoma (ALM), 84 (31.2%) were superficial spreading melanoma (SSM), and 20 (7.5%) were nodular melanoma (NM). SSM patients were characterized by female predominance (77.4%), younger age, and classic melanoma-risk phenotype (fair skin and multiple nevi). Among the 198 invasive cases with a mean follow-up of 56.2 months, the mean (SD) Breslow's thickness was 3.1 (3.6) mm, being 1.4 (1.4) mm in SSM, 3.5 (4.1) mm in ALM and 4.9 (2.9) mm in NM (P<0.001). Ulceration was present in 33.3%, 2.9% in SSM, 38.6% in ALM, and 76.9% in NM (P<0.001). A total of 29.3% relapsed (7.3% of SSM, 35% of ALM and 55% of NM) and 24.2% died because of AM. In multivariate analysis, age at diagnosis, Breslow, and histopathological subtype were independent prognostic factors for both disease-free and AM-specific survival. The ALM and NM subtypes presented poorer outcome after weighting Breslow and age (P=0.02). Histological subtype of AM could have an impact on biological behavior, ALM and NM subtypes presenting a poorer prognosis after adjusting for age and Breslow's thickness.

摘要

肢端黑色素瘤（AM）预后较差，部分原因是诊断延迟，但可能也与该部位的其他内在特征有关。本研究的目的是回顾白种人中AM的具体特征和转归。这是一项横断面回顾性临床病理研究，对1986年至2010年在欧洲一家转诊单位数据库中确诊为AM的274例患者进行研究。患者的平均年龄为56.6（标准差17.7）岁。269例可进行组织学分类并纳入研究。其中，222例（82.5%）位于足部。根据黑色素瘤亚型，165例（61.3%）为肢端雀斑样痣黑色素瘤（ALM），84例（31.2%）为浅表扩散性黑色素瘤（SSM），20例（7.5%）为结节性黑色素瘤（NM）。SSM患者的特点是女性占优势（77.4%）、年龄较轻且具有典型的黑色素瘤风险表型（皮肤白皙和多发痣）。在198例侵袭性病例中，平均随访56.2个月，平均（标准差）Breslow厚度为3.1（3.6）mm，SSM为1.4（1.4）mm，ALM为3.5（4.1）mm，NM为4.9（2.9）mm（P<0.001）。溃疡发生率分别为33.3%、SSM为2.9%、ALM为38.6%、NM为76.9%（P<0.001）。共有29.3%的患者复发（SSM为7.3%、ALM为35%、NM为55%），24.2%的患者因AM死亡。在多变量分析中，诊断时年龄、Breslow厚度和组织病理学亚型是无病生存期和AM特异性生存期的独立预后因素。在对Breslow厚度和年龄进行加权后，ALM和NM亚型的转归较差（P=0.02）。AM的组织学亚型可能对生物学行为有影响，在调整年龄和Breslow厚度后，ALM和NM亚型的预后较差。