McCarthy W H, Shaw H M, McCarthy S W, Rivers J K, Thompson J F
Sydney Melanoma Unit, Royal Prince Alfred Hospital, University of Sydney, Australia.
Semin Oncol. 1996 Dec;23(6):709-13.
Tumor thickness is usually an accurate prognostic indicator for the patient with melanoma. However, very thin primary melanomas occasionally recur locally or metastasize, whereas some patients with very thick primary melanomas survive far longer than expected. There is also a group of patients with primary melanomas of various thicknesses who relapse after a very long disease-free interval. The large database of the Sydney Melanoma Unit which now contains comprehensive long-term follow-up on more than 13,000 patients treated over a 45-year period, has provided a unique opportunity to study melanomas that defy conventional prognostic indicators. Recurrence developed in 2.8% of melanoma patients classified as stage I (pTNM staging system) and with very thin lesions (< 0.50 mm). These recurrences developed more frequently in women than men and histologically were found to be associated with ulceration, high mitotic activity, and invasion to Clark's level IV, but not with regression. Concurrent lymph node metastases (stage III) were present in 3.1% of patients with very thin lesions (< 0.50 mm). In this group, most patients were men, and every lesion displayed regression. Total survival exceeded 15 years in 15.7% of stage II and III patients with very thick lesions (> 5.5 mm). In 1.7% of patients with lesions of any thickness, the disease-free interval before relapse was > 15 years. Neither in patients with very thick lesions surviving for > 15 years, nor in those with a disease-free interval of > 15 years was it consistently possible to show the presence or absence of any of the histological features usually considered to be of prognostic significance.
肿瘤厚度通常是黑色素瘤患者准确的预后指标。然而，极薄的原发性黑色素瘤偶尔会局部复发或转移，而一些原发性黑色素瘤很厚的患者存活时间却远比预期的长。还有一组原发性黑色素瘤厚度各异的患者，在很长的无病间隔期后复发。悉尼黑色素瘤研究中心的大型数据库目前包含了对45年间接受治疗的13000多名患者的全面长期随访信息，为研究那些与传统预后指标不符的黑色素瘤提供了独特的机会。在被归类为I期（pTNM分期系统）且病灶极薄（<0.50 mm）的黑色素瘤患者中，2.8%出现了复发。这些复发在女性中比男性更常见，从组织学上看，复发与溃疡、高有丝分裂活性以及侵犯至克拉克IV级有关，但与消退无关。病灶极薄（<0.50 mm）的患者中有3.1%同时出现了淋巴结转移（III期）。在这组患者中，大多数是男性，且每个病灶都有消退表现。II期和III期且病灶很厚（>5.5 mm）的患者中，15.7%的总生存期超过了15年。在病灶厚度各异的患者中，1.7%在复发前的无病间隔期>15年。无论是生存期>15年的厚病灶患者，还是无病间隔期>15年的患者，都始终无法确定是否存在任何通常被认为具有预后意义的组织学特征。
