Cohen M H, Ketcham A S, Felix E L, Li S H, Tomaszewski M M, Costa J, Rabson A S, Simon R M, Rosenberg S A
Ann Surg. 1977 Nov;186(5):635-42. doi: 10.1097/00000658-197711000-00016.
Review of a 19 year experience in melanoma patients undergoinglymphadenectomy at the National Cancer Institute revealedthat the preoperative assessment of the status of theregional lymph nodes was accurate 91% of the time when thesurgeon felt the nodes were clinically positive, and accurate79% of the time when the nodes were judged clinically negative. The 10-year survival in patients with one to three histologicallypositive nodes or no positive nodes was 50-55%, compared to a25% 8-year survival in patients with four or more histologicallypositive nodes. Stepwise multivariate evaluation of prognosticfactors indicated that the most important factor for predictingprognosis is the number of nodes histologically involved. Nodepalpability was the second most important factor because of itshigh correlation with number of nodes histologically involved. Site of melanoma was the third most important factor, aspatients with extremity (upper or lower) melanoma had a bettersurvival (P = 0.002) than patients with axial melanoma (trunkor head and neck). Five years following lymphadenectomythere appeared to be substantial differences in survivalaccording to differences in the level of invasion of the primarylesion, however, these differences were not nearly aspronounced 10 years following node dissection.B The division of melanoma thicknesses into <1.50 mm and>1.50 mm provided some prognostic discrimination at fiveyears but again the differences were not pronounced 10 yearsfollowing node dissection. The thickness measurements wereeasier to determine than the level of invasion, and more reproduceableon resubmission to the same pathologist. Fourpatients with melanoma less than 0.76 mm had subsequentmetastases, but these may represent inadequate sampling of theprimary melanoma both in our series and in the four similarpatients previously reported with such thin metastasizingmelanomas.
对美国国立癌症研究所19年里接受淋巴结切除术的黑色素瘤患者的回顾显示，当外科医生感觉淋巴结临床阳性时，区域淋巴结状态的术前评估准确率为91%，而当淋巴结被判定临床阴性时，准确率为79%。组织学检查有1至3个阳性淋巴结或无阳性淋巴结的患者10年生存率为50 - 55%，相比之下，组织学检查有4个或更多阳性淋巴结的患者8年生存率为25%。对预后因素进行逐步多变量评估表明，预测预后的最重要因素是组织学累及的淋巴结数量。淋巴结可触及性是第二重要因素，因为它与组织学累及的淋巴结数量高度相关。黑色素瘤的部位是第三重要因素，因为四肢（上肢或下肢）黑色素瘤患者的生存率高于躯干或头颈部等躯干部位黑色素瘤患者（P = 0.002）。淋巴结切除术后5年，根据原发灶浸润程度的不同，生存率似乎存在显著差异，然而，在淋巴结清扫术后10年，这些差异并不那么明显。B 将黑色素瘤厚度分为<1.50 mm和>1.50 mm在5年时提供了一些预后区分，但在淋巴结清扫术后10年，差异再次不明显。厚度测量比浸润程度更容易确定，并且再次提交给同一位病理学家时更具可重复性。4例黑色素瘤厚度小于0.76 mm的患者随后发生转移，但在我们的系列研究以及之前报道的4例类似的薄型转移性黑色素瘤患者中，这些可能代表原发性黑色素瘤的取样不足。
