Division of Oncology B, CRO Aviano National Cancer Institute, Via Franco Gallini 2, 33081, Aviano, Italy.
Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
J Transl Med. 2017 Nov 7;15(1):227. doi: 10.1186/s12967-017-1332-3.
Nodular melanoma (NM) accounts for most thick melanomas and because of their frequent association with ulceration, fast growth rate and high mitotic rate, contribute substantially to melanoma-related mortality. In a multicentric series of 214 primary melanomas including 96 NM and 118 superficial spreading melanoma (SSM), histopathological features were examined with the aim to identify clinicopathological predictors of recurrence.
All consecutive cases of histopathologically diagnosed primary invasive SSM and NM during the period 2005-2010, were retrieved from the 12 participating Italian Melanoma Intergroup (IMI) centers. Each center provided clinico-pathological data such as gender, age at diagnosis, anatomical site, histopathological conventional parameters, date of excision and first melanoma recurrence.
Results showed that NM subtype was significantly associated with Breslow thickness (BT) at multivariate analysis: [BT 1.01-2 mm (OR 7.22; 95% CI 2.73-19.05), BT 2.01-4 mm (OR 7.04; 95% CI 2.54-19.56), and BT > 4 mm (OR 51.78; 95% CI 5.65-474.86) (p < 0.0001)]. Furthermore, mitotic rate (MR) was significantly correlated with NM histotype: [(MR 3-5 mitoses/mm (OR 2.62; 95% CI 1.01-6.83) and MR > 5 mitoses/mm (OR 4.87; 95% CI 1.77-13.40) (p = 0.002)]. The risk of recurrence was not significantly associated with NM histotype while BT [BT 1.01-2.00 mm (HR 1.55; 95% CI 0.51-4.71), BT 2.01-4.00 mm (HR 2.42; 95% CI 0.89-6.54), BT > 4.00 mm. (HR 3.13; 95% CI 0.95-10.28) (p = 0.05)], mitotic rate [MR > 2 mitoses/mm (HR 2.34; 95% CI, 1.11-4.97) (p = 0.03)] and the positivity of lymph node sentinel biopsy (SNLB) (HR 2.60; 95% CI 1.19-5.68) (p = 0.007) were significantly associated with an increased risk of recurrence at multivariate analysis.
We found that NM subtype was significantly associated with higher BT and MR but it was not a prognostic factor since it did not significantly correlate with melanoma recurrence rate. Conversely, increased BT and MR as well as SNLB positivity were significantly associated with a higher risk of melanoma recurrence.
结节性黑色素瘤（NM）占大多数厚黑色素瘤的比例，由于其经常与溃疡、快速生长速度和高有丝分裂率相关，因此对黑色素瘤相关死亡率有很大影响。在包括 96 例 NM 和 118 例浅表扩散性黑色素瘤（SSM）在内的 214 例原发性黑色素瘤的多中心系列中，检查了组织病理学特征，目的是确定与复发相关的临床病理预测因素。
从意大利黑色素瘤研究组（IMI）的 12 个参与中心检索了 2005-2010 年期间经组织病理学诊断的所有连续原发性侵袭性 SSM 和 NM 病例。每个中心都提供了临床病理数据，例如性别、诊断时的年龄、解剖部位、组织病理学常规参数、切除日期和首次黑色素瘤复发。
结果表明，NM 亚型在多变量分析中与 Breslow 厚度（BT）显著相关：[BT 1.01-2mm（OR 7.22；95%CI 2.73-19.05），BT 2.01-4mm（OR 7.04；95%CI 2.54-19.56），和 BT>4mm（OR 51.78；95%CI 5.65-474.86）（p<0.0001）]。此外，有丝分裂率（MR）与 NM 组织类型显著相关：[（MR 3-5 个/毫米（OR 2.62；95%CI 1.01-6.83）和 MR>5 个/毫米（OR 4.87；95%CI 1.77-13.40）（p=0.002）]。复发风险与 NM 组织类型无显著相关性，而 BT [BT 1.01-2.00mm（HR 1.55；95%CI 0.51-4.71），BT 2.01-4.00mm（HR 2.42；95%CI 0.89-6.54），BT>4.00mm（HR 3.13；95%CI 0.95-10.28）（p=0.05）]、有丝分裂率[MR>2 个/毫米（HR 2.34；95%CI，1.11-4.97）（p=0.03）]和前哨淋巴结活检（SNLB）阳性（HR 2.60；95%CI 1.19-5.68）（p=0.007）在多变量分析中与复发风险增加显著相关。
我们发现 NM 亚型与更高的 BT 和 MR 显著相关，但它不是一个预后因素，因为它与黑色素瘤复发率没有显著相关性。相反，BT 和 MR 的增加以及 SNLB 的阳性与黑色素瘤复发的更高风险显著相关。
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