Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy.
Biostatistic, Department of Medical, Oral and Biotechnological Sciences, University G D'Annunzio Chieti-Pescara, Chieti, Italy.
Pigment Cell Melanoma Res. 2020 Sep;33(5):709-718. doi: 10.1111/pcmr.12890. Epub 2020 Jun 11.
Melanomas are skin tumors that show a variety of biological behavior. Some develop very fast and some other grow extremely slow, with metastasis appearing, eventually, many years after the diagnosis. The number of mitoses in primary melanoma has been related to a more aggressive tumor and may have a potential as predictive factor for cutaneous melanoma survival. However, tumor mitotic rate is a static measure and in multivariate analysis on tumor survival, it has scored less than other tumor characteristics. We tried to evolve tumor mitotic rate from a static parameter to a time-dependent one. Similar to the already described growth rate (GR), we propose the speed rate (SR). SR is defined as the ratio of tumor mitotic rate to time to melanoma development. A prospective series of 345 patients with melanoma was investigated for the role of SR as predictive factor for sentinel lymph node (SLN) positivity and tumor progression. We calculated the best threshold for SR and GR to predict the risk of recurrence. Melanoma clinical and histological characteristics as well as GR were correlated in a multivariated analysis with SR. SR values >0.2 mitoses/month were associated with negative prognostic factors such as ulceration (82.8%), SLN positivity (80%), progression (82.8%), and death (85.7%). The association of GR > 0.3 mm/months and SR > 0.2 mitoses/month had a significant predictive value in terms of SLN positivity, progression, and recurrence-free survival. We propose SR as a new "dynamic" predictor of histological SLN positivity and melanoma recurrence risk. We think that he association with this new feature with GR may be helpful in improving the accuracy of predicted clinical outcome of patient especially with thin melanomas.
黑色素瘤是一种表现出多种生物学行为的皮肤肿瘤。有些发展非常快，而有些则生长极其缓慢，最终在诊断后多年才出现转移。原发性黑色素瘤中的有丝分裂数与更具侵袭性的肿瘤有关，并且可能具有作为预测皮肤黑色素瘤生存的潜在因素。然而，肿瘤有丝分裂率是一个静态指标，在肿瘤生存的多变量分析中，其得分低于其他肿瘤特征。我们试图将肿瘤有丝分裂率从静态参数转化为时间依赖性参数。类似于已经描述的生长率 (GR)，我们提出了速度率 (SR)。SR 定义为肿瘤有丝分裂率与黑色素瘤发展时间的比值。我们对 345 例黑色素瘤患者进行了前瞻性研究，以探讨 SR 作为预测前哨淋巴结 (SLN) 阳性和肿瘤进展的预测因子的作用。我们计算了最佳的 SR 和 GR 阈值来预测复发风险。黑色素瘤临床和组织学特征以及 GR 在多变量分析中与 SR 相关。SR 值>0.2 有丝分裂/月与溃疡 (82.8%)、SLN 阳性 (80%)、进展 (82.8%)和死亡 (85.7%)等不良预后因素相关。GR>0.3 mm/月和 SR>0.2 有丝分裂/月的联合具有预测 SLN 阳性、进展和无复发生存率的显著预测价值。我们提出 SR 作为组织学 SLN 阳性和黑色素瘤复发风险的新“动态”预测因子。我们认为，这种新特征与 GR 的关联可能有助于提高对患者尤其是薄型黑色素瘤的临床转归的预测准确性。
