Averbook B J, Russo L J, Mansour E G
Department of Surgery, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio 44109-1998, USA.
Surgery. 1998 Oct;124(4):746-55; discussion 755-6. doi: 10.1067/msy.1998.91269.
A univariate and multivariate statistical analysis of a single surgeon's experience with resectable malignant melanoma during 26 years (November 1970 to August 1996) was conducted.
Six hundred twenty consecutive patients were registered. Univariate analysis of disease-free survival (DFS) and melanoma survival (MS) was calculated by the Kaplan-Meier method and correlated to American Joint Committee on Cancer stage, thickness, ulceration, site, lymph node involvement, age, sex, type, and excision margins. Linear trends, log-rank test, and pairwise comparisons were used to discriminate differences in survival curves. A Cox proportional hazards model was used for multivariate analysis and determination of relative risk.
Univariate analysis of stage, thickness (in millimeters), ulceration, lymph node involvement, age, type, and margins of excision were predictive of DFS (5 years, 85.7%; 10 years, 82.5%) and MS (5 years, 92.2%; 10 years, 87.8%) (P < .01). Multivariate analysis revealed correlations with thickness, ulceration, and age in predicting DFS (relative risk = 2.75, 2.21, and 1.47, respectively) and MS (relative risk = 2.66, 2.47, and 1.48, respectively). The 5-year MS rate was 73.3% and 93.3% for patients with positive and negative lymph nodes, respectively. Of 133 patients who underwent lymph node dissection, 28 (21.1%) had nodal metastases. Patients with primary melanomas thicker than 4 mm had 50% metastatic involvement of their lymph nodes.
Our findings reveal that thickness, ulceration, and age are the most important predicting factors in DFS and MS. The data support including ulceration and age in modifying American Joint Committee on Cancer staging for melanoma.
对一位外科医生在26年（1970年11月至1996年8月）期间治疗可切除恶性黑色素瘤的经验进行了单因素和多因素统计分析。
连续登记了620例患者。采用Kaplan-Meier法计算无病生存期（DFS）和黑色素瘤生存期（MS）的单因素分析，并与美国癌症联合委员会分期、厚度、溃疡、部位、淋巴结受累情况、年龄、性别、类型和切缘相关。使用线性趋势、对数秩检验和两两比较来区分生存曲线的差异。采用Cox比例风险模型进行多因素分析并确定相对风险。
对分期、厚度（以毫米为单位）、溃疡、淋巴结受累情况、年龄、类型和切缘的单因素分析可预测DFS（5年，85.7%；10年，82.5%）和MS（5年，92.2%；10年，87.8%）（P <.01）。多因素分析显示，在预测DFS（相对风险分别为2.75、2.21和1.47）和MS（相对风险分别为2.66、2.47和1.48）方面，与厚度、溃疡和年龄相关。淋巴结阳性和阴性患者的5年MS率分别为73.3%和93.3%。在133例行淋巴结清扫术的患者中，28例（21.1%）有淋巴结转移。原发性黑色素瘤厚度超过4mm的患者，其淋巴结转移率为50%。
我们的研究结果表明，厚度、溃疡和年龄是DFS和MS最重要的预测因素。这些数据支持在修订美国癌症联合委员会黑色素瘤分期时纳入溃疡和年龄因素。
