Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan.
Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
J Formos Med Assoc. 2022 Nov;121(11):2338-2344. doi: 10.1016/j.jfma.2021.12.001. Epub 2021 Dec 25.
This retrospective cohort study enrolled 385 patients diagnosed with cutaneous melanoma from 1980 to 2021 in National Taiwan University Hospital (NTUH). The aim of this study was to investigate the relationship between thickness of primary melanoma lesions and disease outcome of melanoma patients, in particular, those diagnosed with acral lentiginous melanoma (ALM). The association between important clinicopathological characteristics other than tumor thickness and disease outcome was also analyzed. Survival analyses with the Kaplan-Meier method were utilized to investigate the prognoses of patients with different lesion thickness. The male-to-female ratio was 1.12:1. The median age at diagnosis was 63 years old (mean: 62.2 years). There were 283 cases (73.5%) of acral lentiginous melanoma (ALM) with a male-to-female ratio of 1.04:1. Between patients with primary ALM lesions 4.1 millimeters (mm) to 8.0 mm thick and those with lesions over 8.0 mm thick, significant differences in prognostic outcomes including incidence of second recurrences within 1 year (raw p = 0.003, Bonferroni corrected p = 0.009) and distant metastases within 1 year (raw p = 0.003, Bonferroni corrected p = 0.008), were observed. Significantly worse 1-year (raw p = 0.01, Bonferroni corrected p=0.03) and 2-year survival (raw p = 0.006, Bonferroni corrected p = 0.02) were found in ALM patients with lesions of over 8 mm thick than those with lesions 4.1 mm to 8.0 mm at diagnosis. Vigilant short-term follow-up is warranted in ALM patients with lesions of over 8.0 mm thick at diagnosis due to higher risks of adverse outcome.
这项回顾性队列研究纳入了 1980 年至 2021 年期间在国立台湾大学医院（NTUH）诊断为皮肤黑色素瘤的 385 名患者。本研究旨在探讨原发性黑色素瘤病变厚度与黑色素瘤患者疾病结局的关系，特别是肢端雀斑样黑色素瘤（ALM）患者。还分析了除肿瘤厚度以外的重要临床病理特征与疾病结局的关系。采用 Kaplan-Meier 方法进行生存分析，以探讨不同病变厚度患者的预后。患者的男女比例为 1.12:1。中位诊断年龄为 63 岁（平均：62.2 岁）。283 例（73.5%）为肢端雀斑样黑色素瘤（ALM），男女比例为 1.04:1。在原发性 ALM 病变厚度为 4.1 毫米（mm）至 8.0 毫米和病变厚度超过 8.0 毫米的患者之间，在预后结果方面存在显著差异，包括一年内第二次复发的发生率（原始 p=0.003，Bonferroni 校正后 p=0.009）和一年内远处转移的发生率（原始 p=0.003，Bonferroni 校正后 p=0.008）。在 ALM 患者中，病变厚度超过 8.0 毫米的患者 1 年（原始 p=0.01，Bonferroni 校正后 p=0.03）和 2 年（原始 p=0.006，Bonferroni 校正后 p=0.02）的生存率显著更差，与诊断时病变厚度为 4.1mm 至 8.0mm 的患者相比。由于病变厚度超过 8.0 毫米的 ALM 患者发生不良结局的风险较高，因此需要对其进行密切的短期随访。
