Thick primary melanoma has a heterogeneous tumor biology: an institutional series

World Journal of Surgical Oncology

Research

Kobby Asubonteng¹  Gregory Wilding¹  Ari-Nareg Meguerditchian²  John M Kane³  Calvin Young⁴  Bethany Lema⁴ 

[1] Department of Biostatistics, State University of New York, 14214, Buffalo, NY, USA;Department of Surgery, McGill University, H3A 1A1, Montreal, QC, Canada;Department of Surgical Oncology, Roswell Park Cancer Institute, 14263, Buffalo, NY, USA;School of Medicine and Biomedical Sciences, State University of New York, 14214, Buffalo, NY, USA;

关键词: Overall Survival;    Sentinel Lymph Node Biopsy;    Tumor Thickness;    Completion Lymph Node Dissection;    Positive Sentinel Lymph Node Biopsy;   

DOI  :  10.1186/1477-7819-9-40

 received in 2010-09-20, accepted in 2011-04-14,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundThick melanomas (TM) ≥4 mm have a high risk for nodal and distant metastases. Optimal surgical management, prognostic significance of sentinel node biopsy (SLNB), and benefits of interferon (IFN) for these patients are unclear. As a continuum of increasing tumor thickness is placed into a single TM group, differences in biologic and clinical behavior may be lost. The purpose of this study was to better characterize the diverse biology in TM, including the value of increasing thickness and nodal status information, potentially identifying high risk TM subgroups that may warrant more aggressive treatment/follow up.Methods155 consecutive TM patients treated at a single institution between 1971 and 2007 were retrospectively reviewed. Patient, disease and treatment features were analyzed with respect to disease-free (DFS) and overall survival (OS).ResultsMedian patient age was 66 years and 68% of patients were men. The trunk was the most common TM location (35%), followed by the head and neck (29%) and lower extremities (20%). Median thickness was 6 mm and 61% were ulcerated. 6% patients had stage IV disease, 12% had clinical nodal metastases. Clinically negative lymph node basins were treated by observation (22 patients - 15.4%), elective lymph node dissection (ELND) (24 patients - 17.6%) or SLNB (91 patients - 67%). 75% of ELND's and 53% of SLNB's were positive. Completion node dissection was performed in 38 SLNB+ patients and 22% had additional positive nodes. 17% of the study patients received IFN. At median follow up of 26 months, 5 year DFS and OS were 42% and 43.6%. For SLNB positive vs negative, median DFS were 22 vs 111 months (p = 0.006) and median OS were 41 vs 111 months (p = 0.006). When stratified by tumor thickness ≤ vs > 6 mm, 5 year DFS was 58.3% vs 20% (p < 0.0001) and OS was 62% vs 20% (P < 0.0001). IFN had no impact on DFS or OS (p = 0.98 and 0.8 respectively).ConclusionWithin the high risk group of patients with TM, cases with tumor thickness > 6 mm or a positive SLNB had a significantly worse DFS and OS (p < .0001, <.0001 and .006, .006).

【 授权许可】

CC BY   
© Meguerditchian et al; licensee BioMed Central Ltd. 2011