Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Collaborative Innovation Center of Cancer Medicine, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China.
Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China.
Ann Surg Oncol. 2018 Apr;25(4):885-893. doi: 10.1245/s10434-017-6256-x. Epub 2017 Dec 21.
This study was designed to evaluate the efficacy of isolated limb infusion (ILI) treatment in Chinese patients with in-transit melanoma and to identify factors predictive of the outcome.
A total of 150 patients with in-transit melanoma who received a single ILI between 2007 and 2016 were identified from a prospectively collected database.
All patients had AJCC Stages IIIb, IIIc, and IV disease. Acral lentiginous melanoma (ALM) accounted for 79% of patients, and 59% had a high burden of disease (BOD). The complete response (CR) and partial response (PR) rates were 6 and 35%, respectively. Forty-five percent of patients experienced grade III-IV limb toxicities, but no grade V toxicity was observed. Patients with a low BOD, high limb temperature, high peak creatine phosphokinase (CK) level, and grade III-IV limb toxicity achieved higher response rates. Stage IV disease and high BOD were associated with worse infield progression-free survival (PFS) and overall survival (OS), whereas patients with CR or PR to ILI had better infield PFS and OS. Multivariate analyses showed that disease stage, BOD, and a CR were independent predictors of infield PFS, whereas disease stage and a response to ILI were independent predictors of OS.
ILI is well-tolerated but the response rate in Chinese patients was lower than that reported in US and Australian studies. The prevalence of the ALM histological type, advanced disease stages, and a high BOD may be the main reasons for this. A response to ILI, BOD, and disease stage are prognostic factors for survival.
本研究旨在评估孤立肢体灌注（ILI）治疗中国转移性黑色素瘤患者的疗效，并确定预测疗效的因素。
从 2007 年至 2016 年期间，从一个前瞻性收集的数据库中确定了 150 例接受单次 ILI 治疗的转移性黑色素瘤患者。
所有患者均患有 AJCC IIIb、IIIc 和 IV 期疾病。肢端雀斑样黑色素瘤（ALM）占患者的 79%，59%患者疾病负担高（BOD）。完全缓解（CR）和部分缓解（PR）率分别为 6%和 35%。45%的患者出现 3-4 级肢体毒性，但未观察到 5 级毒性。BOD 低、肢体温度高、肌酸磷酸激酶（CK）峰值高和 3-4 级肢体毒性的患者获得了更高的缓解率。IV 期疾病和高 BOD 与较差的场内无进展生存期（PFS）和总生存期（OS）相关，而对 ILI 有 CR 或 PR 的患者具有更好的场内 PFS 和 OS。多变量分析显示，疾病分期、BOD 和 CR 是场内 PFS 的独立预测因素，而疾病分期和 ILI 反应是 OS 的独立预测因素。
ILI 耐受性良好，但中国患者的缓解率低于美国和澳大利亚的研究报告。肢端雀斑样黑色素瘤的高患病率、晚期疾病分期和高 BOD 可能是主要原因。对 ILI 的反应、BOD 和疾病分期是生存的预后因素。
