有丝分裂计数能否改善黑色素瘤患者的个体化预后?
Could the mitotic count improve personalized prognosis in melanoma patients?
机构信息
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
Veneto Tumor Registry, Azienda Zero, Padova, Italy.
出版信息
PLoS One. 2024 Apr 16;19(4):e0302309. doi: 10.1371/journal.pone.0302309. eCollection 2024.
A number of studies have indicated that the mitotic rate may be a predictive factor for poor prognosis in melanoma patients. The aim of this study was to investigate whether the mitotic rate is associated with other prognostic clinical and anatomopathological characteristics. After adjusting for other anatomopathological characteristics, we then verified the prognostic value of the number of mitoses, determining in which population subgroup this variable may have greater prognostic significance on 3-year mortality. The Veneto Cancer Registry (Registro Tumori del Veneto-RTV), a high-resolution population-based dataset covering the regional population of approximately 4.9 million residents, served as the clinical data source for the analysis. Inclusion criteria included all incident cases of invasive cutaneous malignant melanoma recorded in the RTV in 2015 (1,050 cases) and 2017 (1,205 cases) for which the number of mitoses was available. Mitotic classes were represented by Kaplan-Meier curves for short-term overall survival. Cox regression calculated hazard ratios in multivariable models to evaluate the independent prognostic role of different mitotic rate cut-offs. The results indicate that the mitotic rate is associated with other survival prognostic factors: the variables comprising the TNM stage (e.g., tumor thickness, ulceration, lymph node status and presence of metastasis) and the characteristics that are not included in the TNM stage (e.g., age, site of tumor, type of morphology, growth pattern and TIL). Moreover, this study demonstrated that, even after adjusting for these prognostic factors, mitoses per mm2 are associated with higher mortality, particularly in T2 patients. In conclusion, these findings revealed the need to include the mitotic rate in the histological diagnosis because it correlates with the prognosis as an independent factor. The mitotic rate can be used to develop a personalized medicine approach in the treatment and follow-up monitoring of melanoma patients.
一些研究表明有丝分裂率可能是黑色素瘤患者预后不良的预测因素。本研究旨在探讨有丝分裂率是否与其他预后临床和解剖病理学特征相关。在调整其他解剖病理学特征后,我们验证了有丝分裂数目的预后价值,确定在哪些人群亚组中,该变量对 3 年死亡率具有更大的预后意义。威尼托癌症登记处(Registro Tumori del Veneto-RTV)是一个高分辨率的基于人群的数据集,涵盖了约 490 万居民的区域人口,作为分析的临床数据源。纳入标准包括 2015 年(1050 例)和 2017 年(1205 例)在 RTV 中记录的所有侵袭性皮肤恶性黑色素瘤的首发病例,这些病例均有有丝分裂数。有丝分裂等级通过短期总生存率的 Kaplan-Meier 曲线表示。Cox 回归计算多变量模型中的风险比,以评估不同有丝分裂率截止值的独立预后作用。结果表明,有丝分裂率与其他生存预后因素相关:包括 TNM 分期(例如肿瘤厚度、溃疡、淋巴结状态和转移存在)和不包括在 TNM 分期中的变量(例如年龄、肿瘤部位、形态类型、生长模式和 TIL)。此外,本研究表明,即使在调整这些预后因素后,每平方毫米的有丝分裂数与更高的死亡率相关,特别是在 T2 患者中。总之,这些发现表明需要将有丝分裂率纳入组织学诊断,因为它是作为一个独立因素与预后相关。有丝分裂率可用于制定黑色素瘤患者治疗和随访监测的个性化医疗方法。
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