Reintgen D S, Vollmer R, Tso C Y, Seigler H F
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
Arch Surg. 1987 Nov;122(11):1338-42. doi: 10.1001/archsurg.1987.01400230126022.
The outcome of patients with stage I malignant melanoma has been well assessed in terms of prognostic factors and their effect on survival; however, little is known of the recurrence patterns of cutaneous melanoma or the survival of these patients subsequent to recurrence. A retrospective, computer-aided chart review identified 4185 patients with melanoma who had stage I disease clinically. During a follow-up period of one to 14 years, 35.9% suffered a recurrence. Melanoma of the trunk (37.8%) and head and neck area (46.1%) had an increased incidence of recurrent metastases compared with melanoma of the extremities (29.8%). Local regional metastases accounted for 62.5%, 77.3%, and 85.6% of the recurrences in the head and neck, trunk, and extremity primary sites, respectively, with 65% of the relapses occurring within the first three years. Actuarial five-year survival rates of patients who had recurrent disease were significantly decreased compared with those of patients who had no evidence of metastases during their clinical course. A multivariate analysis was performed to estimate the survival of patients after recurrence. One may use this mathematical model to predict the outcome of individual patients after recurrence and provide a more rationally based prognosis for them and their families.
就预后因素及其对生存的影响而言，I期恶性黑色素瘤患者的预后已得到充分评估；然而，关于皮肤黑色素瘤的复发模式或这些患者复发后的生存情况，人们知之甚少。一项回顾性、计算机辅助病历审查确定了4185例临床上患有I期疾病的黑色素瘤患者。在1至14年的随访期内，35.9%的患者出现复发。与四肢黑色素瘤（29.8%）相比，躯干（37.8%）和头颈部（46.1%）黑色素瘤发生复发性转移的发生率更高。局部区域转移分别占头颈部、躯干和四肢原发部位复发的62.5%、77.3%和85.6%，65%的复发发生在头三年。与临床过程中无转移证据的患者相比，复发患者的精算五年生存率显著降低。进行了多变量分析以评估复发后患者的生存情况。人们可以使用这个数学模型来预测个体患者复发后的结局，并为他们及其家人提供更合理的预后。
