Huibers Anne, Leong Stanley P, Kashani-Sabet Mohammed, White Richard L, Vetto John, Schneebaum Schlomo, O'Donoghue Cristina, Howard Harrison, Avisar Eli, Namm Jukes P, Kosiorek Heidi, Faries Mark, Karakousis Giorgos, Zager Jonathan S, Olofsson Bagge Roger
Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Ann Surg Oncol. 2025 May;32(5):3203-3211. doi: 10.1245/s10434-025-17084-4. Epub 2025 Mar 10.
In patients with melanoma, in-transit metastasis (ITM) can develop. This study aimed to identify the risk for a first recurrence of ITM and associated predictive clinical factors in a large international cohort of patients with melanoma.
Patients with primary cutaneous melanoma who underwent wide local excision (WLE) and sentinel lymph node biopsy (SLNB) were identified from the Sentinel Lymph Node Working Group (SLNWG) database between January 1993 and February 2023. Predictive factors for first recurrence of ITM were analyzed.
The study enrolled 7860 patients, and the median follow-up time was 47.1 months (interquartile range [IQR], 19.0-95.0 months). The risk for the development of ITM as a first recurrence was 4.12% (95% confidence interval [CI], 3.63-4.66%) at 5 years. The median time to first ITM recurrence was 15 months (IQR, 7.0-30.0 months). Significant clinicopathologic factors independently associated with an increased risk of ITM in multivariable analysis were increasing Breslow thickness (hazard ratio [HR], 1.37; 95% CI, 1.30-1.43; p < 0.0001), lower-extremity versus trunk melanoma (HR, 2.49; 95% CI, 1.86-3.32; p < 0.0001), increasing age (HR, 1.03; 95% CI, 1.02-1.04; p < 0.0001), number of positive sentinel lymph nodes (SLNs: 1 vs. 0 [HR, 2.24; 95% CI, 1.66-3.01; p < 0.0001] and 2 vs. 0 [HR, 2.37; 95% CI, 1.45-3.88; p = 0.0006]), and presence of vascular invasion (HR, 1.79; 95% CI, 1.21-2.64; p = 0.0035).
The independent risk factors for the development of ITM identified in a large international cohort of melanoma patients were Breslow thickness, lower-extremity melanoma, older age, number of positive SLNs, and presence of vascular invasion.
黑色素瘤患者可能会发生移行转移（ITM）。本研究旨在确定一大群国际黑色素瘤患者首次发生ITM复发的风险及相关的预测性临床因素。
从哨兵淋巴结工作组（SLNWG）数据库中识别出1993年1月至2023年2月期间接受了广泛局部切除（WLE）和前哨淋巴结活检（SLNB）的原发性皮肤黑色素瘤患者。分析了ITM首次复发的预测因素。
该研究纳入了7860例患者，中位随访时间为47.1个月（四分位间距[IQR]，19.0 - 95.0个月）。5年时作为首次复发发生ITM的风险为4.12%（95%置信区间[CI]，3.63 - 4.66%）。首次ITM复发的中位时间为15个月（IQR，7.0 - 30.0个月）。在多变量分析中，与ITM风险增加独立相关的显著临床病理因素包括Breslow厚度增加（风险比[HR]，1.37；95% CI，1.30 - 1.43；p < 0.0001）、下肢黑色素瘤与躯干黑色素瘤相比（HR，2.49；95% CI，1.86 - 3.32；p < 0.0001）、年龄增加（HR，1.03；95% CI，1.02 - 1.04；p < 0.0001）、阳性前哨淋巴结数量（SLNs：1个与0个相比[HR，2.24；95% CI，1.66 - 3.01；p < 0.0001]以及2个与0个相比[HR，2.37；95% CI，1.45 - 3.88；p = 0.0006]），以及血管侵犯的存在（HR，1.79；95% CI，1.21 - 2.64；p = 0.0035）。
在一大群国际黑色素瘤患者中确定的ITM发生的独立危险因素为Breslow厚度、下肢黑色素瘤、年龄较大、阳性SLN数量以及血管侵犯的存在。
