Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
J Cancer Res Clin Oncol. 2021 Sep;147(9):2759-2764. doi: 10.1007/s00432-021-03562-1. Epub 2021 Feb 25.
Nodular melanoma (NM) is associated with worse disease outcome when compared to superficial spreading melanoma (SSM). We aimed to perform a single-center analysis of prognostic factors in patients with NM and compare the data with SSM patients.
We studied 228 patients with NN and 396 patients with SSM. Patients with in situ melanomas or stage IV at diagnosis were not included in the study. Data were analyzed using the Mann-Whitney test, Chi-square test, Kaplan-Meier curves including the log-rank test, and logistic regression model.
When compared to patients with SSM, patients with NM had less likely lower Clark level, higher tumor thickness, less likely tumor regression, more often ulcerated tumors, and less likely a history of precursor lesions such as a nevus. Within a 5-year follow-up we observed significantly more disease relapses and deaths in NM patients than in SSM patients. On multivariate analysis, disease relapse in NM patients was independently predicted by tumor thickness and positive SLNB, whereas melanoma-specific death of NM patients was independently predicted by male sex and tumor thickness. Histologic regression also remained in the logistic regression model as a significant independent negative predictor of NM death.
We did not observe that NM subtype was per se a significant independent predictor for disease relapse or melanoma-specific death. Among the well-known prognostic factors such as tumor thickness and male sex, NM is also associated with other unfavorable factors such as absence of regression.
与浅表扩散性黑色素瘤（SSM）相比，结节性黑色素瘤（NM）的疾病预后更差。我们旨在对 NM 患者的预后因素进行单中心分析，并将数据与 SSM 患者进行比较。
我们研究了 228 例 NM 患者和 396 例 SSM 患者。本研究不包括原位黑色素瘤或诊断时为 IV 期的患者。使用 Mann-Whitney 检验、卡方检验、Kaplan-Meier 曲线（包括对数秩检验）和逻辑回归模型分析数据。
与 SSM 患者相比，NM 患者的Clark 分级较低、肿瘤厚度较高、肿瘤消退较少、溃疡发生率较高、前驱病变（如痣）的病史较少。在 5 年随访期间，NM 患者的疾病复发和死亡明显多于 SSM 患者。多因素分析显示，NM 患者的疾病复发独立预测因素为肿瘤厚度和 SLNB 阳性，而 NM 患者的黑色素瘤特异性死亡独立预测因素为男性和肿瘤厚度。组织学消退在逻辑回归模型中仍然是 NM 死亡的一个显著独立负预测因子。
我们没有观察到 NM 亚型本身是疾病复发或黑色素瘤特异性死亡的显著独立预测因子。在肿瘤厚度和男性等众所周知的预后因素中，NM 还与其他不利因素相关，如无消退。
