Janoff K A, Moseson D, Nohlgren J, Davenport C, Richards C, Fletcher W S
Ann Surg. 1982 Sep;196(3):316-23. doi: 10.1097/00000658-198209000-00010.
One hundred twenty-two clinically Stage I malignant melanoma patients were treated prospectively in a nonrandomized trial by hyperthermic isolation perfusion with l-phenylalanine mustard (l-Pam), regional lymphadenectomy (RL), and wide local excision (WLE) between April 1965 and July 1980. There were 31 males and 91 females. All primary lesions were retrospectively microstaged by Clark's levels and Breslow's thickness criteria by one of the senior authors. Morphologically, 71% were superficial spreading melanomas (SSM), 16.5% were nodular melanomas (NM), and 11.9% were acral lentiginous melanomas. Survival by microstaging and morphology are reported in Table 1. Eighty-one per cent of all patients were disease-free at five years. Twenty-three patients (18.8%) recurred and of these, 15 died of their disease. This included six of the seven patients with histologically positive lymph nodes. Complications were not only acceptable but preventable and will be discussed. Microstaging provides a valid basis by which to compare treatment regimens and, more importantly, a valid criteria by which to select treatment for a given patient. These data compare favorably with other reported series. At the time these studies were initiated, five-year survivals for clinically Stage I and II melanoma were roughly 55% and 15%, respectively. Existing data clearly indicate that hyperthermic isolation perfusion with RL is superior to WLE and warrants further study in selected patients.
1965年4月至1980年7月期间，122例临床I期恶性黑色素瘤患者在一项非随机试验中接受了左旋苯丙氨酸氮芥（l-Pam）热灌注隔离、区域淋巴结清扫术（RL）和广泛局部切除术（WLE）的前瞻性治疗。其中男性31例，女性91例。所有原发性病变均由一位资深作者根据Clark分级和Breslow厚度标准进行回顾性微分期。形态学上，71%为浅表扩散性黑色素瘤（SSM），16.5%为结节性黑色素瘤（NM），11.9%为肢端雀斑样黑色素瘤。按微分期和形态学分类的生存率见表1。所有患者中有81%在五年时无疾病。23例患者（18.8%）复发，其中15例死于该疾病。这包括7例组织学检查淋巴结阳性患者中的6例。并发症不仅是可接受的，而且是可预防的，将进行讨论。微分期为比较治疗方案提供了一个有效的基础，更重要的是，为特定患者选择治疗提供了一个有效的标准。这些数据与其他报道的系列相比具有优势。在开展这些研究时，临床I期和II期黑色素瘤的五年生存率分别约为55%和15%。现有数据清楚地表明，RL热灌注隔离优于WLE，值得在选定患者中进一步研究。
