肢端黑色素瘤患者手术切缘与复发率及生存率的相关性。是否需要广泛切缘？

Recurrence rate and survival implications of surgical margins in patients with acral melanoma. Is a wide margin necessary?

机构信息

Department of Oncological Pathology, Instituto Nacional de Cancerología, Mexico City.

Department of Surgical Oncology, Instituto Nacional de Cancerología, Mexico City.

出版信息

Gac Med Mex. 2023;159(1):38-43. doi: 10.24875/GMM.M22000734.

DOI:10.24875/GMM.M22000734

PMID:36930558

Abstract

INTRODUCTION

Appropriate size of resection margins in acral melanoma is not clearly established.

OBJECTIVE

To investigate whether narrow-margin excision is appropriate for thick acral melanoma.

METHODS

Three-hundred and six patients with acral melanoma were examined. Factors associated with recurrence and survival were analyzed according to surgical margin size (1 to 2 cm and > 2 cm).

RESULTS

Out of 306 patients, 183 were women (59.8%). Median Breslow thickness was 6 mm; 224 cases (73.2%) were ulcerated, 154 patients (50.3%) had clinical stage III disease, while 137 were at stage II (44.8%) and 15 at stage IV (4.9%). All cases had negative margins, with a median of 31.5 mm. A Breslow thickness of 7 mm (p = 0.001) and clinical stage III (p = 0.031) were associated with recurrence; the factors associated with survival were Breslow index (p = 0.047), ulceration (p = 0.003), advanced clinical stage (p < 0.001), and use of adjuvant therapy (p = 0.003).

CONCLUSION

A resection margin of 1 to 2 cm did not affect tumor recurrence or survival in patients with acral melanoma.

摘要

简介

在肢端黑色素瘤中，适当的切除边缘大小尚不清楚。

目的

研究窄切缘切除是否适用于厚型肢端黑色素瘤。

方法

对 306 例肢端黑色素瘤患者进行检查。根据手术边缘大小（1 至 2 厘米和大于 2 厘米）分析与复发和生存相关的因素。

结果

306 例患者中，女性 183 例（59.8%）。Breslow 厚度中位数为 6 毫米；224 例（73.2%）溃疡，154 例（50.3%）临床分期为 III 期，137 例为 II 期（44.8%），15 例为 IV 期（4.9%）。所有病例均为切缘阴性，中位数为 31.5 毫米。Breslow 厚度为 7 毫米（p = 0.001）和临床分期 III 期（p = 0.031）与复发相关；与生存相关的因素有 Breslow 指数（p = 0.047）、溃疡（p = 0.003）、晚期临床分期（p < 0.001）和辅助治疗的应用（p = 0.003）。