Callery C, Cochran A J, Roe D J, Rees W, Nathanson S D, Benedetti J K, Elashoff R M, Morton D L
Ann Surg. 1982 Jul;196(1):69-75. doi: 10.1097/00000658-198207000-00015.
To establish clinical and histologic determinants of survival, records of all UCLA patients with resectable melanoma metastatic to the lymph nodes during the years 1954-1976 were reviewed. These 150 patients were treated first with wide excision, lymphadenectomy, and with radiation/chemotherapy and/or additional surgery only if further recurrences developed. None received adjuvant immunotherapy or chemotherapy. In 97 of 139 patients with identified primary tumors, slides of the primary lesion were reviewed. Putative prognostic factors included age, sex, parity, site of primary tumor, presence of satellitosis, clinical status of nodes, histologic characteristics of primary lesion (Clark's level, thickness of tumor, presence/width of ulceration, and number of mitoses/HPF), time from biopsy of primary tumor to lymphadenectomy, and number of positive nodes. kaplan-Meier estimates of survival for the entire group at one, two, five, and ten years were 73, 55, 37, and 33%, respectively. Median follow-up period of survivors was four years. Univariate analyses using the log-rank test showed that thickness of the primary lesion (p less than 0.001), width of ulceration (p = 0.003), absence of ulceration (p = 0.024), and number of positive nodes (p = 0,.033) were prognostic for survival. In multivariate analysis by the Cox procedure, thickness of the primary (p = 0.001) and number of melanoma-containing nodes (p = 0.043) were prognostic for survival. Location of the primary tumor became marginally significant (p = 0.12) in the multrivariate model. These findings demonstrate the prognostic importance of characteristics of both the primary lesion and extent of regional dissemination. Future prospective randomized trials for (adjuvant) therapy of Stage II melanoma should be stratified by these variables.
为确定生存的临床和组织学决定因素，我们回顾了1954年至1976年间所有加州大学洛杉矶分校可切除的转移性黑色素瘤患者的记录。这150例患者首先接受了广泛切除、淋巴结清扫术，只有在出现进一步复发时才接受放疗/化疗和/或额外手术。没有人接受辅助免疫治疗或化疗。在139例已确定原发性肿瘤的患者中，有97例对原发性病变的切片进行了复查。假定的预后因素包括年龄、性别、生育情况、原发性肿瘤部位、卫星灶的存在、淋巴结的临床状态、原发性病变的组织学特征（克拉克分级、肿瘤厚度、溃疡的存在/宽度以及每高倍视野的有丝分裂数）、从原发性肿瘤活检到淋巴结清扫术的时间以及阳性淋巴结的数量。整个组在1年、2年、5年和10年的Kaplan-Meier生存估计分别为73%、55%、37%和33%。幸存者的中位随访期为4年。使用对数秩检验的单变量分析表明，原发性病变的厚度（p<0.001）、溃疡宽度（p = 0.003）、无溃疡（p = 0.024）以及阳性淋巴结的数量（p = 0.033）对生存具有预后意义。通过Cox程序进行的多变量分析显示，原发性肿瘤的厚度（p = 0.001）和含黑色素瘤淋巴结的数量（p = 0.043）对生存具有预后意义。在多变量模型中，原发性肿瘤的位置变得具有边缘显著性（p = 0.12）。这些发现证明了原发性病变特征和区域播散范围对预后的重要性。未来针对II期黑色素瘤（辅助）治疗的前瞻性随机试验应根据这些变量进行分层。
