Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland.
Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland; St. Mary's Regional Medical Center, Surgery, Lewiston, ME.
Surgery. 2018 Sep;164(3):589-593. doi: 10.1016/j.surg.2018.04.016. Epub 2018 Jun 19.
Tumor mitotic rate is a known prognostic variable in Stage I melanoma; however, its importance is unclear in Stages II and III.
Patients diagnosed with nonmetastatic cutaneous melanoma from 2010 to 2014 were identified from the National Cancer Institute's Surveillance, Epidemiology, and End Results registry.
Of a total of 71,235 patients, the majority were white (94.7%), male (58.5%), and had a Stage I tumor (79.0%). On univariable analysis, 5-year disease-specific survival decreased with each increasing tumor mitotic rate category of 0-3, 4-10, and >10 mitoses/mm (Stage I 98.3%, 90.9%, 79.7%; Stage II 86.1%, 74.2%, 72.9%; and Stage III 72.5%, 58.6%, 49.7%). In multivariable models, tumor mitotic rate as both a continuous and categorical variable was associated with disease-specific survival for Stages I-III melanoma. Each unit increase in tumor mitotic rate increased the risk of death by 23% in Stage I, 5% in Stage II, and 3% in Stage III. Compared with the 0-3 tumor mitotic rate category, the risk of disease-specific mortality increased for tumors in the 4-10 and >10 categories for Stage I (RR 3.07 and 6.74, P < .0001), Stage II (RR 1.37 and 1.62, P = .0002), and Stage III (RR 1.24 and 1.35, P = .0004).
In this cohort study, tumor mitotic rate is an independent predictor of survival for localized melanoma.
肿瘤有丝分裂率是 I 期黑色素瘤的已知预后变量；然而，其在 II 期和 III 期的重要性尚不清楚。
从美国国家癌症研究所的监测、流行病学和最终结果登记处确定了 2010 年至 2014 年期间诊断为非转移性皮肤黑色素瘤的患者。
在总共 71235 名患者中，大多数是白人（94.7%）、男性（58.5%）和 I 期肿瘤（79.0%）。在单变量分析中，5 年疾病特异性生存率随每增加一个肿瘤有丝分裂率类别而降低，分别为 0-3、4-10 和>10 个有丝分裂/mm（I 期为 98.3%、90.9%、79.7%；II 期为 86.1%、74.2%、72.9%；III 期为 72.5%、58.6%、49.7%）。在多变量模型中，肿瘤有丝分裂率作为连续和分类变量与 I-III 期黑色素瘤的疾病特异性生存率相关。肿瘤有丝分裂率每增加一个单位，I 期黑色素瘤的死亡风险增加 23%，II 期黑色素瘤的死亡风险增加 5%，III 期黑色素瘤的死亡风险增加 3%。与 0-3 个肿瘤有丝分裂率类别相比，4-10 个和>10 个肿瘤有丝分裂率类别的肿瘤在 I 期（RR 3.07 和 6.74，P<.0001）、II 期（RR 1.37 和 1.62，P=0.0002）和 III 期（RR 1.24 和 1.35，P=0.0004）的疾病特异性死亡率风险增加。
在这项队列研究中，肿瘤有丝分裂率是局部黑色素瘤生存的独立预测因子。
