Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
J Am Acad Dermatol. 2018 May;78(5):935-941. doi: 10.1016/j.jaad.2017.11.041. Epub 2017 Dec 1.
The American Joint Commission on Cancer will remove mitotic rate from its staging guidelines in 2018.
Using a large nationally representative cohort, we examined the association between mitotic rate and lymph node positivity among thin melanomas.
A total of 149,273 thin melanomas in the National Cancer Database were examined for their association of high-risk features of mitotic rate, ulceration, and Breslow depth with lymph node status.
Among 17,204 patients with thin melanomas with data on Breslow depth, ulceration, and mitotic rate who underwent a lymph node biopsy, there was a strong linear relationship between odds of having a positive lymph node and mitotic rate (R = 0.96, P < .0001, β = 3.31). The odds of having a positive node increased by 19% with each 1-point increase in mitotic rate (odds ratio, 1.19; 95% confidence interval, 1.17-1.21). Cases with negative nodes had a mean mitotic rate of 1.54 plus or minus 2.07 mitoses/mm compared with 3.30 plus or minus 3.54 mitoses/mm for those with positive nodes (P < .0001).
The data collected do not allow for survival analyses.
Mitotic rate was strongly associated with the odds of having a positive lymph node and should continue to be reported on pathology reports.
2018 年，美国癌症联合委员会将从其分期指南中删除有丝分裂率。
利用一项大型全国代表性队列研究，我们检验了有丝分裂率与薄型黑色素瘤淋巴结阳性之间的相关性。
对国家癌症数据库中的 149273 例薄型黑色素瘤进行了研究，分析了有丝分裂率、溃疡和 Breslow 深度等高危特征与淋巴结状态的相关性。
在 17204 例有 Breslow 深度、溃疡和有丝分裂率数据并接受淋巴结活检的薄型黑色素瘤患者中，有丝分裂率与淋巴结阳性的可能性之间存在很强的线性关系（R=0.96，P<.0001，β=3.31）。有丝分裂率每增加 1 点，淋巴结阳性的可能性增加 19%（优势比，1.19；95%置信区间，1.17-1.21）。淋巴结阴性的病例有丝分裂率平均为 1.54±2.07 个/毫米，而淋巴结阳性的病例有丝分裂率为 3.30±3.54 个/毫米（P<.0001）。
所收集的数据不允许进行生存分析。
有丝分裂率与淋巴结阳性的可能性密切相关，应继续在病理报告中报告。
