Geelhoed G W, Breslow A, McCune W S
Am Surg. 1977 Feb;43(2):77-85.
Sixty melanoma patients were followed 20 to 30 years after primary therapy, and survival rates were reviewed with reference to clinical and histological staging. All but one of the patients with clinically positive regional nodes died of metastatic disease. Two of nine patients with nonenlarged nodes that were clinically negative but histologically positive are alive 25 years after node dissections. Ten of 17 patients with negative nodes survived their operations by 20 to 30 years. Another series of 138 patients with stage 1 cutaneous melanoma were reviewed at the George Washington University Medical Center and tumor thickness was found to be a better measurement of prognosis than clinical or histologic staging, or the tumor's level of invasion. Prophylactic lymph node dissection appeared to double the survival of patients with lesions greater than 1.5 millimeters thick, but had no effect on those with thinner lesions. Thirty-nine per cent of the patients had lesions less than 0.76 mm thick, and all survived free of disease for five or more years. Of the tumors in the intermediate range of 0.76 to 1.50 mm thick, 33% metastasized or recurred; no clinical or pathologic discriminant could be detected that differentiated those patients who would have the recurring lesions from the others with tumors in this range of intermediate thickness who did well.
60例黑色素瘤患者在接受初始治疗后随访了20至30年，并根据临床和组织学分期对生存率进行了评估。除1例临床区域淋巴结阳性患者外，其余患者均死于转移性疾病。9例临床阴性但组织学阳性的未增大淋巴结患者中有2例在淋巴结清扫术后25年仍存活。17例淋巴结阴性患者中有10例术后存活了20至30年。乔治华盛顿大学医学中心对另一组138例I期皮肤黑色素瘤患者进行了评估，发现肿瘤厚度比临床或组织学分期以及肿瘤浸润水平更能准确预测预后。预防性淋巴结清扫似乎使肿瘤厚度大于1.5毫米的患者生存率提高了一倍，但对较薄病变的患者无效。39%的患者肿瘤厚度小于0.76毫米，所有患者均无病存活5年或更长时间。在厚度介于0.76至1.50毫米之间的肿瘤中，33%发生转移或复发；在这一中等厚度范围内，无法检测到任何临床或病理特征来区分哪些患者会出现复发病变，哪些患者病情良好。
