Hartley J W, Fletcher W S
Division of Surgical Oncology, Oregon Health Sciences University, Portland 97201.
J Surg Oncol. 1987 Nov;36(3):170-4. doi: 10.1002/jso.2930360305.
Between 1964 and 1983, 65 patients with Stage II extremity melanoma were treated in a nonrandomized fashion with wide local excision, lymph node dissection, and hyperthermic perfusion with 1-phenylalanine mustard at 1.0-1.5 mg/kg. Southwest Oncology Group Stage II criteria were used, including IIA (node positive), IIB/C (recurrent local/regional), or both. During the study interval, literature reports of 5-year survival for Stage II melanoma ranged from 6% to 50% and averaged approximately 26% to 30%. In this study group, 40% of patients had recurrent disease confined to regional lymph nodes, 33% had recurrent cutaneous disease, and 26% had recurrent disease in both locations. Survival for all Stage II patients at 5 years was 56.6%, and 40% at 10 years. When recurrent disease was confined to regional nodes only (IIA), survival at 5 years was 70.5%, and 40% at 10 years. Survival for patients with Stage IIB/C disease at 5 and 10 years was 58% and 43.7%. When recurrent melanoma was present in both skin and nodes, 5-year survival was 29%. The present study indicates that aggressive treatment of Stage II extremity melanoma, which includes hyperthermic isolation perfusion, can prolong survival in these high-risk patients.
1964年至1983年间，65例II期肢体黑色素瘤患者接受了非随机的广泛局部切除、淋巴结清扫以及1-苯丙氨酸氮芥1.0 - 1.5 mg/kg的热灌注治疗。采用西南肿瘤协作组II期标准，包括IIA期（淋巴结阳性）、IIB/C期（局部/区域复发）或两者兼具。在研究期间，文献报道的II期黑色素瘤5年生存率为6%至50%，平均约为26%至30%。在该研究组中，40%的患者复发疾病局限于区域淋巴结，33%有皮肤复发疾病，26%在两个部位均有复发疾病。所有II期患者的5年生存率为56.6%，10年生存率为40%。当复发疾病仅局限于区域淋巴结（IIA期）时，5年生存率为70.5%，10年生存率为40%。IIB/C期疾病患者的5年和10年生存率分别为58%和43.7%。当皮肤和淋巴结均出现复发黑色素瘤时，5年生存率为29%。本研究表明，对II期肢体黑色素瘤进行积极治疗，包括热隔离灌注，可延长这些高危患者的生存期。
