Faculty of Medicine and Health Sciences, School of Life Sciences, University of Nottingham, Nottingham, UK.
Cellular Pathology Department, Nottingham University Hospital, Nottingham, UK.
J Cutan Pathol. 2024 Apr;51(4):288-298. doi: 10.1111/cup.14561. Epub 2023 Dec 15.
Several prognostic factors for primary cutaneous melanoma (PCM) have been identified, and these predict metastasis and survival, to a certain extent. We sought to determine the frequency of angiotropism (AT) and lymphovascular invasion (LVI) in PCM and the relationship between AT, LVI, and other clinicopathological parameters and patient's prognosis.
This study included 538 cases of PCM diagnosed between 2003 and 2016. It comprised 246 females and 292 males whose clinicopathological variables were evaluated with respect to LVI and AT using univariate and multivariate analyses. Overall survival (OS) was assessed by Kaplan-Meier (KM) analysis and Cox regression multivariate analysis.
AT occurred more frequently than LVI. Ulceration, mitotic rate, and Breslow thickness were found to be highly associated with both LVI and AT (p < 0.01). All LVI+ cases had AT, with a significant positive correlation (p < 0.01). Both AT and LVI predicted lymph node (LN) metastasis (odds ratio [OR] = 1.47, 1.12, respectively). Multivariate analysis showed LN metastasis, Breslow thickness, LVI, and AT as predictors of OS. LVI and AT independently predicted adverse OS by Cox regression analysis (hazard ratio [HR] = 1.66, 1.49, respectively) and with KM survival analysis.
AT is a marker for angiotropic extravascular migratory tumor spread (angiotropic EVMM), and LVI is a marker for intra-lymphovascular tumor spread. Both predict poor prognosis. Given its ease of detection, AT could be adopted as a histologpathological feature in the routine assessment of primary cutaneous malignant melanoma cases.
已确定了一些原发性皮肤黑素瘤（PCM）的预后因素，这些因素在一定程度上预测了转移和生存。我们试图确定 PCM 中血管侵袭（AT）和淋巴管浸润（LVI）的频率，以及 AT、LVI 与其他临床病理参数和患者预后之间的关系。
本研究纳入了 2003 年至 2016 年间诊断的 538 例 PCM 病例，其中包括 246 名女性和 292 名男性。使用单变量和多变量分析评估 LVI 和 AT 与肿瘤临床病理参数的关系。通过 Kaplan-Meier（KM）分析和 Cox 回归多变量分析评估总生存率（OS）。
AT 的发生率高于 LVI。溃疡、有丝分裂率和 Breslow 厚度与 LVI 和 AT 高度相关（p<0.01）。所有 LVI+病例均存在 AT，两者呈显著正相关（p<0.01）。AT 和 LVI 均预测淋巴结（LN）转移（优势比[OR]分别为 1.47 和 1.12）。多变量分析显示 LN 转移、Breslow 厚度、LVI 和 AT 是 OS 的预测因素。LVI 和 AT 独立通过 Cox 回归分析预测不良 OS（风险比[HR]分别为 1.66 和 1.49），并通过 KM 生存分析。
AT 是血管外迁移性肿瘤扩散的血管侵袭标志物（血管侵袭性 EVMM），LVI 是淋巴管内肿瘤扩散的标志物。两者均预测预后不良。鉴于其易于检测，AT 可作为常规评估原发性皮肤恶性黑素瘤病例的组织病理学特征。
