Institute of Oncology, Istanbul University, Istanbul, Turkey.
Department of Medical Oncology, Koc University, Istanbul, Turkey.
Jpn J Clin Oncol. 2021 May 28;51(6):873-878. doi: 10.1093/jjco/hyab031.
Stage III melanoma is a heterogenous disease, and the number of tumor-involved lymph nodes is the most significantly unfavorable prognostic indicator for relapse and outcome. The aim of this study is to investigate the possible effects of the various clinicopathological factors on the course of node-positive stage III disease.
A total of 389 node-positive stage III cutaneous melanomas were included in the study and analyzed retrospectively. All underwent pathological nodal staging by sentinel lymph node biopsy or elective lymph node dissection.
The group was male-dominant (59%) and the median age was 50 years. The largest group of patients was N1 (n = 221, 56.8%) followed by N2 (n = 105, 27.0%) and N3 (n = 63, 16.2%). N1 melanomas were less frequently associated with relapses than melanomas with multiple lymph node metastases (P = 0.05). The 5-year relapse-free survival rate was 37.9%. The melanomas with multiple lymph nodes metastases (P = 0.01), higher mitotic rate (P = 0.005) and ulceration (P = 0.02) had worse RFS. In the multivariate analysis only the significances of the N2-N3 stage (P = 0.016) and higher mitosis (P = 0.012) persisted. The severe lymph node metastasis (N2-N3) was associated with a higher mortality rate in comparison with the single nodal involvement (P = 0.05). The 5-year overall survival rate was 52.1%. Presence of relapse (P = 0.0001), higher mitotic rate (P = 0.03) and N2-N3 stage (P = 0.04) were inversely correlated with the overall survival. When relapse was included in the multivariate analysis, it was the only significant prognostic factor on survival (P = 0.0001), whereas mitosis became the only significant factor on survival with the exclusion of relapse from the multivariate analysis (P = 0.031).
In node-positive stage III melanoma, tumor mitotic rate might be just as significant a prognostic indicator as the metastatic lymph node number.
III 期黑色素瘤是一种异质性疾病，受累淋巴结的数量是复发和预后最显著的不利预后指标。本研究旨在探讨各种临床病理因素对阳性淋巴结 III 期疾病过程的可能影响。
本研究共纳入 389 例阳性淋巴结 III 期皮肤黑色素瘤患者，进行回顾性分析。所有患者均行前哨淋巴结活检或选择性淋巴结清扫术进行病理淋巴结分期。
该组以男性为主（59%），中位年龄为 50 岁。最大的患者群体为 N1（n=221，56.8%），其次是 N2（n=105，27.0%）和 N3（n=63，16.2%）。与多发淋巴结转移的黑色素瘤相比，N1 黑色素瘤复发率较低（P=0.05）。5 年无复发生存率为 37.9%。多发淋巴结转移（P=0.01）、较高有丝分裂率（P=0.005）和溃疡（P=0.02）的黑色素瘤患者 RFS 较差。多变量分析仅显示 N2-N3 期（P=0.016）和较高有丝分裂率（P=0.012）的意义持续存在。与单个淋巴结受累相比，严重淋巴结转移（N2-N3）与死亡率较高相关（P=0.05）。5 年总生存率为 52.1%。存在复发（P=0.0001）、较高有丝分裂率（P=0.03）和 N2-N3 期（P=0.04）与总生存率呈负相关。当将复发纳入多变量分析时，它是唯一对生存有显著影响的预后因素（P=0.0001），而当将复发从多变量分析中排除时，有丝分裂成为唯一对生存有显著影响的因素（P=0.031）。
在阳性淋巴结 III 期黑色素瘤中，肿瘤有丝分裂率可能与转移淋巴结数量一样是重要的预后指标。
