Slingluff C L, Vollmer R T, Reintgen D S, Seigler H F
Duke University Medical Center, Durham, NC 27710.
Ann Surg. 1988 Aug;208(2):150-61. doi: 10.1097/00000658-198808000-00004.
Thin melanomas can metastasize and be lethal. The purpose of this review was to identify negative risk factors in patients with melanomas less than 0.76 mm thick. Six hundred and eighty-one (681) such patients are reviewed in this study. Of those referred without metastatic disease (583 patients), metastases developed in 4.8% after a mean followup of 3.6 years. Of those referred with metastatic disease (98 patients), mortality was 35% after a mean followup of 5.9 years. Male patients (p less than 0.04) and patients with axial primaries (p less than 0.05) were at an increased risk of metastasis. Severe histologic regression was present in 40% of the primary lesions that metastasized and in only 17% of similar lesions that did not (p less than 0.001). Increased age was associated with increased local skin metastases, but not with increased nodal or distant metastases. A prognostic model was designed, using two clinical risk factors (axial primary site and male sex) and two histologic risk factors (Clark's Level IV and severe histologic regression). The prognostic model identified a low-risk population--women with extremity primaries--with an actuarial risk of metastasis at 10 years that was less than 3%. Patients with either (1) both clinical risk factors or (2) one clinical risk factor and one histologic risk factor were identified as high-risk patients. Their actuarial risk of metastasis was 11% at 5 years and 22% at 10 years (p = 0.0084). Identifying high-risk and low-risk patients with thin melanomas may improve guidelines for the application of adjuvant therapies to this population.
薄型黑色素瘤可发生转移并具有致死性。本综述的目的是确定厚度小于0.76 mm的黑色素瘤患者的负性危险因素。本研究对681例此类患者进行了回顾。在那些初诊时无转移疾病的患者（583例）中，平均随访3.6年后，4.8%发生了转移。在那些初诊时已有转移疾病的患者（98例）中，平均随访5.9年后，死亡率为35%。男性患者（p<0.04）和原发灶位于躯干部位的患者（p<0.05）发生转移的风险增加。40%发生转移的原发灶存在严重组织学消退，而未发生转移的相似病灶中仅有17%存在严重组织学消退（p<0.001）。年龄增加与局部皮肤转移增加相关，但与淋巴结或远处转移增加无关。利用两个临床危险因素（躯干部位原发和男性）和两个组织学危险因素（克拉克分级IV级和严重组织学消退）设计了一个预后模型。该预后模型确定了一个低风险人群——四肢原发灶的女性——其10年转移的精算风险小于3%。具有以下情况之一的患者被确定为高风险患者：（1）两个临床危险因素均存在；或（2）一个临床危险因素和一个组织学危险因素。他们5年转移的精算风险为11%，10年为22%（p=0.0084）。识别薄型黑色素瘤的高风险和低风险患者可能会改善针对该人群辅助治疗应用的指南。
