Portelli F, Galli F, Cattaneo L, Cossa M, De Giorgi V, Forte G, Fraternali Orcioni G, Gianatti A, Indini A, Labianca A, Maurichi A, Merelli B, Montesco M C, Occelli M, Patuzzo R, Piazzalunga D, Pigozzo J, Quaglino P, Ribero S, Salvatori R, Saraggi D, Sena P, Senetta R, Valeri B, Tanaka M, Fukayama M, Palmieri G, Mandalà M, Massi D
Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy.
Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
Br J Dermatol. 2021 Feb;184(2):281-288. doi: 10.1111/bjd.19120. Epub 2020 Jun 15.
The presence of ulceration has been recognized as an adverse prognostic factor in primary cutaneous melanoma (PCM).
To investigate whether the extent of ulceration (EoU) predicts relapse-free survival (RFS) and overall survival (OS) in PCM.
We retrieved data for 477 patients with ulcerated PCM from databases of the Italian Melanoma Intergroup. Univariate and multivariable Cox proportional hazard models were used to assess the independent prognostic impact of EoU.
A significant interaction emerged between Breslow thickness (BT) and EoU, considering both RFS (P < 0·0001) and OS (P = 0·0006). At multivariable analysis, a significant negative impact of EoU on RFS [hazard ratio (HR) (1-mm increase) 1·26, 95% confidence interval (CI) 1·08-1·48, P = 0·0047] and OS [HR (1-mm increase) 1·25, 95% CI 1·05-1·48, P = 0·0120] was found in patients with BT ≤ 2 mm, after adjusting for BT, age, tumour-infiltrating lymphocytes, sentinel lymph node status and mitotic rate. No impact of EoU was found in patients with 2·01-4 mm and > 4 mm BT.
This study demonstrates that EoU has an independent prognostic impact in PCM and should be recorded as a required element in pathology reports.
溃疡的存在已被认为是原发性皮肤黑色素瘤（PCM）的不良预后因素。
研究溃疡程度（EoU）是否可预测PCM的无复发生存期（RFS）和总生存期（OS）。
我们从意大利黑色素瘤协作组的数据库中检索了477例溃疡型PCM患者的数据。采用单变量和多变量Cox比例风险模型评估EoU的独立预后影响。
考虑RFS（P < 0·0001）和OS（P = 0·0006）时，Breslow厚度（BT）和EoU之间出现显著交互作用。在多变量分析中，在调整了BT、年龄、肿瘤浸润淋巴细胞、前哨淋巴结状态和有丝分裂率后，发现EoU对BT≤2 mm的患者的RFS[风险比（HR）（每增加1 mm）1·26，95%置信区间（CI）1·08 - 1·48，P = 0·0047]和OS[HR（每增加1 mm）1·25，95% CI 1·05 - 1·48，P = 0·0120]有显著负面影响。在BT为2·01 - 4 mm和> 4 mm的患者中未发现EoU的影响。
本研究表明EoU在PCM中有独立的预后影响，应作为病理报告中的必需要素记录下来。
