Wada Maiko, Ito Takamichi, Tsuji Gaku, Nakahara Takeshi, Hagihara Akihito, Furue Masutaka, Uchi Hiroshi
Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Research and Clinical Center for Yusho and Dioxin, Kyushu University, Fukuoka, Japan.
J Dermatol. 2017 Aug;44(8):932-938. doi: 10.1111/1346-8138.13834. Epub 2017 Mar 24.
We summarize herein our 14-year experience of conventional treatment outcomes before the era of molecular-targeted therapy and immunotherapy. Specifically, we conducted a retrospective review of our 252 patients with primary cutaneous melanoma (acral lentiginous melanoma [ALM], n = 121; non-acral lentiginous melanoma [non-ALM], n = 131), and compared the prognostic factors between ALM and non-ALM. Melanoma-specific survival and disease-free survival were estimated using the Kaplan-Meier method. Regarding the results, all patients were Japanese (106 male and 146 female), with a mean age of 60.1 years. Among ALM patients, age was elder and primary tumor size was larger than non-ALM. As for tumor thickness, in situ lesions were more frequently observed in ALM. There was no significant difference in the distribution of tumor thickness between the two groups when excluding the in situ lesions. For treatment of the primary melanoma, 248 patients (98.4%) had undergone curative surgical excision and 120 patients with more than 1 mm or ulcerated melanoma had undergone sentinel lymph node biopsy. Patients with systemic metastasis primarily underwent dacarbazine-based chemotherapy. The Kaplan-Meier survival curves revealed no significant difference in melanoma-specific survival and disease-free survival between those with ALM and non-ALM. The results also showed that both ALM and non-ALM, when they initially metastasize, first affect the regional lymph nodes. Incisional biopsy was not an adverse prognostic factor. These results suggest that ALM does not differ in its biological behavior from non-ALM, so we can consider ALM as being equivalent to non-ALM. The initial treatment for ALM and non-ALM can involve the same strategy.
在此，我们总结了在分子靶向治疗和免疫治疗时代之前，我们14年的传统治疗结果经验。具体而言，我们对252例原发性皮肤黑色素瘤患者（肢端雀斑样痣黑色素瘤[ALM]，n = 121；非肢端雀斑样痣黑色素瘤[非ALM]，n = 131）进行了回顾性研究，并比较了ALM和非ALM之间的预后因素。采用Kaplan-Meier法估计黑色素瘤特异性生存率和无病生存率。结果显示，所有患者均为日本人（男性106例，女性146例），平均年龄60.1岁。在ALM患者中，年龄比非ALM患者大，原发肿瘤大小也更大。至于肿瘤厚度，原位病变在ALM中更常见。排除原位病变后，两组肿瘤厚度分布无显著差异。对于原发性黑色素瘤的治疗，248例患者（98.4%）接受了根治性手术切除，120例肿瘤厚度超过1mm或溃疡型黑色素瘤患者接受了前哨淋巴结活检。发生全身转移的患者主要接受以达卡巴嗪为基础的化疗。Kaplan-Meier生存曲线显示，ALM和非ALM患者的黑色素瘤特异性生存率和无病生存率无显著差异。结果还表明，ALM和非ALM在最初发生转移时，首先累及区域淋巴结。切取活检不是不良预后因素。这些结果表明，ALM的生物学行为与非ALM无异，因此我们可以认为ALM与非ALM相当。ALM和非ALM的初始治疗可采用相同的策略。
