Harrist T J, Rigel D S, Day C L, Sober A J, Lew R A, Rhodes A R, Harris M N, Kopf A W, Friedman R J, Golomb F M
Cancer. 1984 May 15;53(10):2183-7. doi: 10.1002/1097-0142(19840515)53:10<2183::aid-cncr2820531029>3.0.co;2-9.
A multivariate analysis was performed on 20 clinical and histologic variables from 327 Stage I prospectively studied melanoma patients who underwent elective regional lymph node dissection (ERLD). Primary tumor thickness, microscopic satellites, and the elapsed interval between diagnosis and ERLD, were selected as the combination of variables that were most highly associated with clinically occult regional lymph node metastases (P = 10(-15), model chi-square). Microscopic satellites were defined as tumor nests, greater than 0.05 mm in diameter, in the reticular dermis, panniculus, or vessels beneath the principal invasive tumor mass but separated from it by normal tissue on the section in which the Breslow measurement was taken. The probability of finding nodal metastases for melanomas less than 0.75 mm thick was 0% (0/41 patients); for those 0.76-1.50 mm, 4% (4/108); 1.51-3.0 mm, 14% (14/102); and greater than 3.0 mm, 39.5% (30/76). Primary melanomas greater than 1.50 mm thick with microscopic satellites were more often associated with nodal metastases than those of similar thickness without satellites (30/57 (53%) versus 14/121 (12%), P = 0.01). Some satellites probably represent intraspecimen metastases, while others do not. Any predictive model for occult regional lymph node metastases based on data from ERLD done less than 50 days after diagnosis may underestimate the prevalence of metastases.
对327例接受选择性区域淋巴结清扫术（ERLD）的Ⅰ期前瞻性研究的黑色素瘤患者的20项临床和组织学变量进行了多变量分析。原发性肿瘤厚度、微小卫星灶以及诊断与ERLD之间的时间间隔，被选为与临床隐匿性区域淋巴结转移相关性最高的变量组合（P = 10⁻¹⁵，模型卡方值）。微小卫星灶定义为在网状真皮、皮下组织或主要浸润肿瘤块下方的血管中直径大于0.05 mm的肿瘤巢，但在进行Breslow测量的切片上与主要肿瘤块被正常组织分隔开。厚度小于0.75 mm的黑色素瘤发生淋巴结转移的概率为0%（0/41例患者）；厚度为0.76 - 1.50 mm的为4%（4/108）；1.51 - 3.0 mm的为14%（14/102）；大于3.0 mm的为39.5%（30/76）。厚度大于1.50 mm且有微小卫星灶的原发性黑色素瘤比厚度相似但无卫星灶的黑色素瘤更常伴有淋巴结转移（30/57（53%）对14/121（12%），P = 0.01）。一些卫星灶可能代表标本内转移，而其他的则不是。基于诊断后不到50天进行的ERLD数据建立的任何隐匿性区域淋巴结转移预测模型可能会低估转移的发生率。
