背景:在发达国家,原发性皮肤黑色素瘤仍然是皮肤癌死亡的主要原因,近年来发病率一直在稳步上升,令人担忧的方式。
目的:本研究评估了临床,这种疾病的流行病学和人口统计学方面,并将其与患者预后相关。
方法:使用流行病学和临床数据,我们分析了1990年至2007年间治疗的84例轻度至重度原发性皮肤黑色素瘤患者.分析了包含手术标本的载玻片,必要时,从存档的石蜡切片制作新的载玻片。
结果:黑素瘤的发病率在阳光照射区域较高,通常在男性的躯干中观察到病变,和女性的下肢。除了Breslow的厚度和溃疡(分别为p=0.043和p<0.001),每毫米有丝分裂率(2)也与患者预后较差相关(p=0.0007).溃疡的总和(不存在时为0,存在时为1),Breslow指数(当<1毫米时,为1,2当>1mm和<4mm时,3时>4mm)和有丝分裂指数(0时不存在或1时每mm(2))允许建立预后评分:如果总和等于或大于3,几乎所有(91.7%)患者都有全身性疾病.5年生存率约为70%。
结论:因为美国癌症分期加入委员会将在不久的将来更新恶性肿瘤(TNM)分期的分类,并引入有丝分裂作为预后因素,我们的结果显示了这一特征的重要性.需要额外的研究来证实本文提出的预后评分的重要性。
BACKGROUND: Primary cutaneous melanoma still constitutes the main cause of skin cancer death in developed countries, and its incidence in recent years has been increasing in a steady, worrisome manner.
OBJECTIVE: This
study evaluated the clinical, epidemiological and demographic aspects of this disease, and correlated them with patient prognosis.
METHODS: Using epidemiologic and clinical data, we analyzed 84 patients with mild to severe primary cutaneous melanoma treated between 1990 and 2007. Slides containing surgical specimens were analyzed, and new slides were made from archived paraffin sections when necessary.
RESULTS: The melanoma incidence was higher in areas of sun exposure, with lesions commonly observed in the trunk for males, and lower limbs for females. In addition to Breslow\'s thickness and ulceration (p = 0.043 and p < 0.001, respectively), the mitotic rate per mm(2) also correlated with worse patient outcome (p = 0.0007). The sum of ulceration (0 when absent or 1 when present), the Breslow index (1 when <1 mm, 2 when >1 mm and <4 mm, 3 when >4 mm) and the mitotic index (0 when absent or 1 when > or =1 per mm(2)) allowed the establishment of a prognostic score: if the sum was equal to or over three, nearly all (91.7%) patients had systemic disease. The 5-year survival was approximately seventy percent.
CONCLUSIONS: Because American Join Committee of Cancer Staging will update the classification of malignant tumors (TNM) staging in the near future, and introduce mitosis as a prognostic factor, our results show the importance of such a feature. Additional studies are necessary to confirm the importance of a prognostic score as proposed herein.