Drepper H, Biess B, Hofherr B, Hundeiker M, Lippold A, Otto F, Padberg G, Peters A, Wiebelt H
Fachklinik Hornheide, Münster, Germany.
Cancer. 1993 Feb 15;71(4):1239-46. doi: 10.1002/1097-0142(19930215)71:4<1239::aid-cncr2820710412>3.0.co;2-q.
Prognostic factors for patients with stage III melanoma are still controversial.
Two hundred eighty-six patients with solitary cutaneous malignant melanoma of the skin in Stage III (International Union Against Cancer [UICC]) were followed up for as long as 11 years.
Patients in risk group pT 4a, pN O (primary tumor thickness of more than 4 mm or invasion of subcutis and absence of regional lymph node metastasis in elective lymph node specimen) have a 5-year survival rate of 72.8%. If regional metastases are excluded clinically (pT 4a, NO), the 5-year survival rate is 62.8%. Patients with regional lymph node metastases have an average 5-year survival rate of 39%, depending mainly on the number of involved lymph nodes and the depth infiltration of the primary tumor. The number of involved lymph nodes reflects the grade of dissemination. It shows a stronger correlation with the prognosis than does the size of metastases.
The authors recommend that revisions of the UICC classification should distinguish Stage IIIA and IIIB based on the presence or absence of regional metastases and that a clearer distinction should be made between regional cutaneous or subcutaneous metastases and regional lymph node metastases.
III期黑色素瘤患者的预后因素仍存在争议。
对286例III期（国际抗癌联盟[UICC]）皮肤孤立性皮肤恶性黑色素瘤患者进行了长达11年的随访。
风险组pT 4a、pN 0（原发肿瘤厚度超过4mm或侵犯皮下组织且选择性淋巴结标本中无区域淋巴结转移）的患者5年生存率为72.8%。若临床排除区域转移（pT 4a，N0），5年生存率为62.8%。有区域淋巴结转移的患者5年平均生存率为39%，主要取决于受累淋巴结的数量和原发肿瘤的浸润深度。受累淋巴结的数量反映了播散程度。它与预后的相关性比转移灶大小更强。
作者建议UICC分类的修订应根据是否存在区域转移区分IIIA期和IIIB期，并且应更明确地区分区域皮肤或皮下转移与区域淋巴结转移。
