Laks Shachar, Meyers Michael O, Deal Allison M, Frank Jill S, Stitzenberg Karyn B, Yeh Jen Jen, Thomas Nancy E, Ollila David W
Am Surg. 2017 Sep 1;83(9):972-978.
Tumor mitotic rate (TMR) is a known prognostic variable in thin melanoma patients. Its significance in stage II melanoma patients is yet to be demonstrated. Retrospective analysis of a prospective melanoma database from 9/1997 to 7/2015 was performed. All stage II melanoma, with documented TMR, and six months of follow-up were included. We evaluated the association of clinicopathologic variables, TMR, as a continuous and categorical variable with recurrence-free survival (RFS) and overall survival (OS) using Cox proportional hazards modeling. We used a statistical model, X-tile, to develop optimal categorizations of TMR. A total of 265 patient characteristics are included in this study. Recurrences occurred in 82 (30.9%) patients, including 5 local, 41 regional, and 36 distant patients. In multivariate model, ulceration, Breslow, and continuous TMR were associated with worse RFS\OS. Continuous TMR demonstrated worse RFS (hazards ratio [HR] 1.02 (1.00-1.05)) and OS (HR 1.02 (1.00-1.04)), whereas dichotomized TMR (≥1 vs <1) was not significant. TMR >10.4 mitoses/mm2 has a 5-year RFS\OS of 27.2 and 44.3 per cent, respectively, compared with 57.4 and 71.4 per cent, respectively, for TMR <3.2 mitoses/mm2. Continuous TMR predicts incidence of recurrence in stage II melanoma. We propose a new categorization method developed by statistical modeling for optimal stratification that may guide surveillance for this disparate patient population.
肿瘤有丝分裂率（TMR）是薄型黑色素瘤患者已知的预后变量。其在II期黑色素瘤患者中的意义尚待证实。对1997年9月至2015年7月的前瞻性黑色素瘤数据库进行了回顾性分析。纳入了所有有记录TMR且随访6个月的II期黑色素瘤患者。我们使用Cox比例风险模型评估了临床病理变量、作为连续和分类变量的TMR与无复发生存期（RFS）和总生存期（OS）之间的关联。我们使用一种统计模型X-tile来制定TMR的最佳分类。本研究共纳入265例患者特征。82例（30.9%）患者出现复发，包括5例局部复发、41例区域复发和36例远处复发。在多变量模型中，溃疡、Breslow厚度和连续TMR与较差的RFS/OS相关。连续TMR显示较差的RFS（风险比[HR]1.02（1.00 - 1.05））和OS（HR 1.02（1.00 - 1.04）），而二分法TMR（≥1 vs <1）无显著性差异。与TMR <3.2个有丝分裂/平方毫米时分别为57.4%和71.4%相比，TMR>10.4个有丝分裂/平方毫米时5年RFS/OS分别为27.2%和44.3%。连续TMR可预测II期黑色素瘤的复发发生率。我们提出一种通过统计建模开发的新分类方法，用于最佳分层，这可能会指导对这一不同患者群体的监测。
