Månsson-Brahme E, Carstensen J, Erhardt K, Lagerlöf B, Ringborg U, Rutqvist L E
Department of Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
Cancer. 1994 May 1;73(9):2324-32. doi: 10.1002/1097-0142(19940501)73:9<2324::aid-cncr2820730914>3.0.co;2-5.
Thin melanomas can metastasize and be lethal. The predictive importance of tumor thickness in thin melanomas and the specific features identifying the patients at risk have not been investigated fully.
Prognostic factors were analyzed in 585 patients with clinical Stage I invasive cutaneous malignant melanoma with a thickness of less than or equal to 0.8 mm. The patients were included in a population-based cancer registry in Stockholm county during 1976-1987. They constituted about 64% of all patients with thin melanomas who were diagnosed in the region during the study period. Information was available on age, sex, anatomic site of the tumor, histologic type of melanoma, level of invasion, tumor thickness, and tumor regression. In a Cox regression analysis, the prognostic importance of each factor was studied. By a case-control technique with individual matching for the identified independent predictors of recurrence, the additional prognostic information given by type and grade of inflammatory response, presence of vertical growth phase, mitotic rate/mm2, and histologic ulceration of the tumor was assessed.
After a median follow-up time of 50 months, recurrent disease developed in 26 patients (4%). There was no difference in recurrence rate between patients treated with narrow (1-2 cm) or wide (5 cm) excision. Anatomic site, tumor thickness, level of invasion, and tumor regression were found to be independent prognostic factors in the multivariate analysis. In the case-control study, only grade of inflammatory reaction added significant prognostic information. No subgroup could be identified that was without risk of recurrent disease.
Thin melanomas do not seem to constitute a separate form of melanoma, but compose one end of a continuous spectrum of biologic behavior.
薄型黑色素瘤可发生转移并具有致死性。肿瘤厚度在薄型黑色素瘤中的预测重要性以及识别高危患者的具体特征尚未得到充分研究。
对585例临床I期侵袭性皮肤恶性黑色素瘤厚度小于或等于0.8mm的患者的预后因素进行分析。这些患者于1976 - 1987年纳入斯德哥尔摩县基于人群的癌症登记处。他们约占研究期间该地区诊断出的所有薄型黑色素瘤患者的64%。可获得有关年龄、性别、肿瘤解剖部位、黑色素瘤组织学类型、浸润深度、肿瘤厚度和肿瘤消退情况的信息。在Cox回归分析中，研究了每个因素的预后重要性。通过病例对照技术，对已确定的复发独立预测因素进行个体匹配，评估炎症反应类型和分级、垂直生长期的存在、每平方毫米有丝分裂率以及肿瘤组织学溃疡所提供的额外预后信息。
中位随访时间50个月后，26例患者（4%）出现复发性疾病。采用窄切缘（1 - 2cm）或宽切缘（5cm）切除的患者复发率无差异。在多变量分析中，解剖部位、肿瘤厚度、浸润深度和肿瘤消退是独立的预后因素。在病例对照研究中，只有炎症反应分级增加了显著的预后信息。未发现无复发性疾病风险的亚组。
薄型黑色素瘤似乎并非黑色素瘤的一种单独形式，而是构成了生物学行为连续谱的一端。
