Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.
Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Ann Surg Oncol. 2018 Apr;25(4):894-902. doi: 10.1245/s10434-017-6325-1. Epub 2018 Jan 12.
Counterintuitively, more deaths from melanoma occur among patients with thin (T1) primary melanomas (≤ 1 mm) than among those with thick primary melanoma because the great majority present with T1 tumors. Therefore, it is important to stratify their risk as accurately as possible to guide their management and follow-up. This study sought to explore the relationship between tumor thickness and prognosis for patients with thin primary melanomas.
A retrospective, single-institution study investigated 6263 patients with cutaneous melanoma (including 2117 T1 cases) who had a minimum follow-up period of 10 years.
For the entire patient cohort, the 10-year melanoma-specific survival (MSS) rate ranged between 92% for the patients with primary melanomas up to 0.3 mm thick and 32% for those with melanomas thicker than 8 mm. When divided into 25-quantile-thickness groups there was a significant difference in 10-year MSS between the two consecutive groups 0.8 and 0.9 mm; the differences in survival were not significantly different for any other consecutive cut points within the less than or equal to 1 mm thickness range, indicating a biologically-relevant difference in outcome above and below 0.8 mm. For the patients treated initially at the authors' institution, the 10- and 20-year MSS rates for those with tumors up to 0.8 mm thick were respectively 93.4 and 85.7%, and for tumors 0.9 to 1.0 mm, the rates were respectively 81.1 and 71.4%. Only 29.3% of the T1 patients who died of melanoma were deceased within 5 years.
A naturally occurring thickness cut point of 0.8 mm predicts higher or lower risk for patients with thin primary cutaneous melanomas. Long-term follow-up assessment of patients with T1 melanoma is important because late mortality due to melanoma is more common than early mortality.
反直觉的是，患有薄（T1）原发性黑素瘤（≤1mm）的患者比患有厚原发性黑素瘤的患者死于黑素瘤的情况更多，因为绝大多数患者表现为 T1 肿瘤。因此，尽可能准确地分层其风险以指导其管理和随访非常重要。本研究旨在探讨肿瘤厚度与薄原发性黑素瘤患者预后之间的关系。
回顾性单机构研究调查了 6263 名患有皮肤黑素瘤（包括 2117 例 T1 病例）的患者，这些患者的最低随访期为 10 年。
对于整个患者队列，原发性黑素瘤厚度达 0.3mm 的患者 10 年黑素瘤特异性生存率（MSS）范围为 92%，而黑素瘤厚度大于 8mm 的患者为 32%。当分为 25 个定量厚度组时，连续两组 0.8 和 0.9mm 之间的 10 年 MSS 存在显著差异；在小于或等于 1mm 厚度范围内的任何其他连续切分点，生存差异均无统计学意义，表明在 0.8mm 以上和以下的结果存在生物学上的显著差异。对于最初在作者所在机构接受治疗的患者，肿瘤厚度达 0.8mm 以下的患者 10 年和 20 年 MSS 率分别为 93.4%和 85.7%，肿瘤厚度为 0.9 至 1.0mm 的患者，相应的 MSS 率分别为 81.1%和 71.4%。死于黑素瘤的 T1 患者中，仅有 29.3%在 5 年内死亡。
自然发生的厚度截断值 0.8mm 可预测薄原发性皮肤黑素瘤患者的高风险或低风险。对 T1 黑素瘤患者进行长期随访评估很重要，因为黑素瘤的晚期死亡率高于早期死亡率。
