Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, U.S.A.
Department of Surgery, Mayo Clinic, Jacksonville, FL, U.S.A.
Anticancer Res. 2020 Feb;40(2):1065-1069. doi: 10.21873/anticanres.14044.
BACKGROUND/AIM: Margin size during wide excisional surgery for invasive melanoma treatment have been established by national guidelines. This study identified factors associated with wider than recommended excisional margins and its impact on survival.
The National Cancer Database was queried to identify patients with primary invasive melanoma. Statistical analysis was performed using univariate and multivariate analysis. Overall survival was compared using Kaplan-Meier method.
A total of 26,440 patients were included in the analysis. Melanomas located on the trunk were more likely to be treated using wider than recommended excisional margins for certain Breslow depth groups (p<0.05), while the opposite was true for those being treated in an academic/research program (p<0.05). The practice of taking wider than recommended margins was not associated with improved survival.
Tumor location and facility type influence non-compliance with the National Comprehensive Cancer Network guidelines. Lack of survival benefit in patients with wider excisional margins seems to support guideline recommendations.
背景/目的：国家指南已经确定了用于治疗侵袭性黑色素瘤的广泛切除术的切缘大小。本研究旨在确定与推荐的切缘宽度相比更宽的切缘相关因素及其对生存的影响。
本研究通过国家癌症数据库查询了患有原发性侵袭性黑色素瘤的患者。使用单变量和多变量分析进行统计分析。使用 Kaplan-Meier 方法比较总生存率。
共纳入 26440 名患者进行分析。对于某些 Breslow 深度组，位于躯干的黑色素瘤更有可能采用比推荐宽度更大的切缘进行治疗（p<0.05），而在学术/研究项目中接受治疗的黑色素瘤则相反（p<0.05）。采用比推荐宽度更大的切缘的做法与改善生存无关。
肿瘤位置和医疗机构类型影响对国家综合癌症网络指南的不遵守情况。对于具有更宽切缘的患者，缺乏生存获益似乎支持指南建议。
