DOI QR코드

DOI QR Code

Treatment Outcome and Prognostic Factors for Malignant Skin Melanoma Treated with Radical Surgery

  • Majewski, Wojciech (Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology) ;
  • Stanienda, Karolina (Scientific Association, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology) ;
  • Wicherska, Katarzyna (Scientific Association, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology) ;
  • Ulczok, Rafal (Clinic of Cancer Surgery, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology) ;
  • Wydmanski, Jerzy (Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology)
  • 발행 : 2015.09.02

초록

Aim: To assess the treatment outcome in patients with malignant skin melanoma and prognostic factors for distant metastases (DM), disease-free survival (DFS) and overall survival (OS). Materials and Methods: A retrospective analysis was conducted on 113 patients with malignant skin melanoma (60 females, 53 males, average age-55 years) who were treated surgically. Primary treatment consisted of local excision. In 12 cases, it was accompanied by lymph node excision. In 93 (82%) cases, radicalization was necessary, which was either local only (19 cases) or accompanied by lymph node surgery/biopsy (74 cases). Possible prognostic factors such as Clark's stage and Breslow's depth of invasion, ulceration, average tumor dimensions, lymph nodes metastases (pN+), gender, tumor location and primary excision margins were considered. Results: In 51 (45%) cases, treatment failure occurred. The 5-year DM rate was 47%, the 5-year DFS was 38%, and the 5-year OS was 56%. In the univariate analysis, the important factors with respect to at least one endpoint included Clark's stage, Breslow's depth of invasion, ulceration, average tumor dimensions, lymph nodes metastases, gender and primary tumor localization. The presence of metastasic nodes was the most important prognostic factor, with a 5-year DM rates of 30% for pN(-) and 76% for pN(+) and a 5-year DFS and OS of 56% and 76% for pN(-) and 13% and 24% for pN(+), respectively. The average tumor dimension was independently significant for DFS and OS, with 5-year rates of 69% and 80% for ${\leq}1cm$, 28% and 53% for 1-2 cm, and 18% and 30% for >2 cm, respectively. Tumor location was also significant for DM and OS, with 5-year rates of 69% vs 33% and 41% vs 66% for trunk vs other locations, respectively. Conclusions: The natural course of a malignant skin melanoma treated radically is disadvantageous, with unsuccessful outcome in nearly half of the cases. Common clinical factors, such as Clark's tumor stage, Breslow's depth of invasion and the presence of metastatic nodes, have high prognostic significance. The size and location of the primary lesion may be considered independent prognostic factors. The most important negative prognostic factor is the presence of metastatic regional lymph nodes. Only one quarter of patients with metastases in lymph nodes survive 5 years from primary surgery.

참고문헌

  1. Barnhill RL, Fine JA, Roush GA, Berwick M (1996). Predicting five-year outcome for patients with cutaneous melanoma in a population-based study. Cancer, 78, 427-32 https://doi.org/10.1002/(SICI)1097-0142(19960801)78:3<427::AID-CNCR8>3.0.CO;2-G
  2. Bentzen MS, Thames HD (1996). Tumor volume and local control probability: Clinical data and radiobiological interpretations. Int J Radiation Oncology Biol Phys, 36, 247-51
  3. Berwick M, Armstrong BK, Ben-Porat L, et al (2005). Sun exposure and mortality from melanoma. J Natl Cancer Inst, 97, 195-9 https://doi.org/10.1093/jnci/dji019
  4. Burmeister BH, Henderson MA, Ainslie J et al (2012). Adjuvant radiotherapy versus observation alone for patients at risk of lymph node field relapse after therapeutic lymphadenectomy for melanoma: a randomised trial. Lancet Oncol, 13, 589-97 https://doi.org/10.1016/S1470-2045(12)70138-9
  5. Callery Ch, Cochran AJ, Roe DJ, et al (1982). Factors prognostic for survival in patients with malignant melanoma spread to the regional lymph nodes. Ann Surg, 196, 69-75 https://doi.org/10.1097/00000658-198207000-00015
  6. Deshmane V, Kalloli M, Chikaraddi S, et al (2014). Predictive factors for loco regional recurrence and distant metastasis following primary surgical treatment of cutaneous melanoma. Indian J Dermatol, 59, 241-6 https://doi.org/10.4103/0019-5154.131383
  7. Dummer R, Hauschild A, Guggenheim M, et al (2012). Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 23, 86-91 https://doi.org/10.1093/annonc/mdr033
  8. Gajda M, Kaminska-Winciorek G (2014). Do not let to be late: Overview of reasons for melanoma delayed diagnosis. Asian Pac J Cancer Prev, 15, 3873-7 https://doi.org/10.7314/APJCP.2014.15.9.3873
  9. Gamsizkan M, Yilmaz I, Buyukbabani N, et al (2014). A retrospective multicenter evaluation of cutaneous melanomas in Turkey. Asian Pac J Cancer Prev, 15, 10451-6
  10. Gandini S, De Vries E, Tosti G, et al (2013). Sunny holidays before and after melanoma diagnosis are respectively associated with lower breslow thickness and lower relapse rates in italy. Plos One, 8.
  11. Garbe C, Buttner P, Bertz J et al (1995). Primary cutaneous melanoma. Identification of prognostic groups and estimation of individual prognosis for 5093 patients. Cancer, 75, 2484-91 https://doi.org/10.1002/1097-0142(19950515)75:10<2484::AID-CNCR2820751014>3.0.CO;2-U
  12. Garbe C, Buttner P, Bertz J, et al (1995). Primary cutaneous melanoma. prognostic classification of anatomic location. Cancer, 75, 2492-8. https://doi.org/10.1002/1097-0142(19950515)75:10<2492::AID-CNCR2820751015>3.0.CO;2-W
  13. Kaminska-Winciorek G, Gajda M, Wydmanski J, Tukiendorf A (2015). What do web users know about skin self-examination and melanoma symptoms. Asian Pac J Cancer Prev, 16, 3051-6 https://doi.org/10.7314/APJCP.2015.16.7.3051
  14. Lasithiotakis K, Leiter U, Meier F, et al (2008). Age and gender are significant independent predictors of survival in primary cutaneous melanoma. Cancer, 112, 1795-804. https://doi.org/10.1002/cncr.23359
  15. Lens MB, Dawes M, Goodacre T, Newton-Bishop JA (2002). Elective lymph node dissection in patients with melanoma: systematic review and meta-analysis of randomized controlled trials. Arch Surg, 137, 458-61
  16. Mackie RM, Hauschild A, Eggermont AM (2009). Epidemiology of invasive cutaneous melanoma. Ann Oncol, 20, 1-7
  17. Melanoma. NCCN clinical practice guidelines in oncology. Version, 3, 2-24.
  18. Mervic L (2012). Prognostic factors in patients with localized primary cutaneous melanoma. Acta Dermatovenerol APA, 21, 27-31
  19. Micheli A, Ciampichini R, Oberaigner W, et al (2009). The advantage of women in cancer survival: an analysis of EUROCARE-4 data. Eur J Cancer, 45, 1017-27 https://doi.org/10.1016/j.ejca.2008.11.008
  20. Morton DL, Wanek L, Nizze JA, et al. (1991). Improved long-term survival after lypmhadenectomy of melanoma metastatic to regional nodes. Ann Surg, 214, 491-9 https://doi.org/10.1097/00000658-199110000-00013
  21. Scoggins CR, Ross MI, Reintgen DS, et al (2006). Genderrelated differences in outcome for melanoma patients. Ann Surg, 243, 693-8 https://doi.org/10.1097/01.sla.0000216771.81362.6b
  22. Scoggins CR, Bowen AL, Martin RC II, et al (2010). Prognostic information from sentinel lymph node biopsy in patients with thick melanoma. Arch Surg, 145, 622-7 https://doi.org/10.1001/archsurg.2010.115
  23. Slingluff CL, Flaherty K, Rosenberg SA, Read PW (2011). Cutaneous melanoma. In De Vita VT, Lawrence TS, Rosenberg SA. Cancer Principles PractOncol. Lippincott, Wiliams and Wilkins
  24. Teixeira V, Vieira R, Coutinho I, et al (2013). Prediction of sentinel node status and clinical outcome in a melanoma centre. J Skin Cancer. 2013, 904701
  25. Thompson JF, Scolyer RA, Kefford RF (2005). Cutaneous melanoma. Lancet, 365, 687-701 https://doi.org/10.1016/S0140-6736(05)70937-5
  26. White RR, Stanley WE, Johnson JL, et al (2002). Long-Term Survival in 2,505 Patients With Melanoma With Regional Lymph Node Metastasis. Ann Surg, 235, 879-87 https://doi.org/10.1097/00000658-200206000-00017
  27. de Vries E, Bray FI, Coebergh JW, Parkin DM (2003). Changing epidemiology of malignant cutaneous melanoma in Europe 1953-1997: Rising trends in incidence and mortality but recent stabilizations in western Europe and decreases in Scandinavia. Int J Cancer, 107, 119-26 https://doi.org/10.1002/ijc.11360
  28. de Vries E, Nijsten TE, Visser O, et al (2008). Superior survival of females among 10,538 Dutch melanoma patients is independent of Breslow thickness, histologic type and tumor site. Ann Oncol, 19, 583-9
  29. Wojciechowska U, Didkowska J (2015), Zachorowania I zgony na nowotwory zlosliwe w Polsce. Krajowy Rejestr Nowotworow www.onkologia.org.pl,

피인용 문헌

  1. Circulating epigenetic biomarkers in melanoma vol.37, pp.2, 2016, https://doi.org/10.1007/s13277-015-4599-0