Sober A J, Day C L, Fitzpatrick T B, Lew R A, Kopf A W, Mihm M C
J Invest Dermatol. 1983 Jun;80 Suppl:50s-52s.
We studied 13 prognostic factors in 582 patients with clinical stage I melanoma to determine which factor or combination of factors was associated with death from melanoma within the first 24 months following diagnosis. Thirty-six patients died during this period. Only 2 deaths occurred in patients with primary tumors thinner than 1.70 mm, and only 2 patients of 189 died with tumors located on the non-BANS extremities, excluding the hands and feet. Individual factors associated with high risk for death within 2 years included level V tumors, acral location, thickness greater than or equal to 3.65 mm, histologic ulceration greater than 3 mm, nodular type, presence of microscopic satellites, greater than 6 mitoses/mm2, positive elective node dissection, absence of lymphocyte response at the tumor base, and absence of an associated nevus histologically. Many of the preceding individual factors are highly correlated. By the use of logistic regression analysis, only one very high risk group was found: 71 percent of patients with level V tumors greater than 1.70 mm thick with histologic ulceration width greater than 3 mm located in an area other than the extremities (excluding hands and feet) had died within 2 years of diagnosis. The ability to select high-risk groups should be useful to investigators involved with the design and evaluation of adjuvant therapy studies.
我们对582例临床I期黑色素瘤患者的13个预后因素进行了研究，以确定哪些因素或因素组合与诊断后最初24个月内黑色素瘤死亡相关。在此期间有36例患者死亡。原发肿瘤厚度小于1.70 mm的患者中仅2例死亡，189例肿瘤位于非BANS肢体（不包括手和脚）的患者中仅2例死亡。与2年内高死亡风险相关的个体因素包括V级肿瘤、肢端部位、厚度大于或等于3.65 mm、组织学溃疡大于3 mm、结节型、存在微小卫星灶、有丝分裂数大于6个/mm²、选择性淋巴结清扫阳性、肿瘤基底无淋巴细胞反应以及组织学上无相关痣。上述许多个体因素高度相关。通过逻辑回归分析，仅发现一个极高风险组：71%的V级肿瘤厚度大于1.70 mm、组织学溃疡宽度大于3 mm、位于非肢体部位（不包括手和脚）的患者在诊断后2年内死亡。选择高风险组的能力对参与辅助治疗研究设计和评估的研究人员应是有用的。
