DeBoer D K, Schwartz H S, Thelman S, Reynolds V H
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-2550, USA.
Clin Orthop Relat Res. 1996 Feb(323):277-83. doi: 10.1097/00003086-199602000-00038.
In this study, the authors examine the survivorship of individuals who constitute the small subset of patients with Stage IV melanoma who present with their first and only detectable metastasis to the skeleton. One thousand two hundred six patients were identified with primary melanoma at the authors' institution since 1962. There were 14 patients with isolated (solitary) skeletal metastases. Survival was calculated by Kaplan-Meier technique. The survival rate for any individual with an isolated metastasis to the axial skeleton was 0. Three of 8 patients with melanoma metastases to the appendicular skeleton are alive at 18, 25, and 52 months after Stage IV detection. A statistically significant prolonged latency period (initial diagnosis to Stage IV) in the appendicular group compared with the axial group contributed to their significant survival rate advantage. The melanoma literature strongly supports the complete resection of soft tissue metastatic foci. These data support this concept and extend it to include isolated skeletal metastases. The mechanisms by which axial and appendicular skeletal metastases occur are significantly different. This difference manifests itself as a survival advantage for the appendicular group and warrants an aggressive surgical approach for these individuals.
在本研究中，作者对构成IV期黑色素瘤患者小亚组的个体的生存情况进行了研究，这些患者首次出现且仅出现可检测到的骨骼转移。自1962年以来，作者所在机构共识别出1206例原发性黑色素瘤患者。其中有14例发生孤立（单发）骨骼转移。采用Kaplan-Meier技术计算生存率。任何发生孤立性轴向骨骼转移的个体的生存率为零。8例发生黑色素瘤肢体骨骼转移的患者中有3例在IV期确诊后18、25和52个月时仍存活。与轴向组相比，肢体组从初始诊断到IV期有统计学意义的更长潜伏期，这导致了其显著的生存率优势。黑色素瘤文献强烈支持对软组织转移灶进行完整切除。这些数据支持这一概念，并将其扩展到包括孤立性骨骼转移。轴向和肢体骨骼转移发生的机制显著不同。这种差异表现为肢体组的生存优势，因此对这些个体应采取积极的手术方法。
