期刊
JOURNAL OF CLINICAL ONCOLOGY
卷 29, 期 16, 页码 2199-2205出版社
AMER SOC CLINICAL ONCOLOGY
DOI: 10.1200/JCO.2010.31.5812
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资金
- American Joint Committee on Cancer
- National Cancer Institute [P30 CA13148]
- National Institutes of Health Specialized Program of Research Excellence (SPORE) melanoma [P50 CA93459]
- Merck/Schering-Plough
Purpose The aim of this study was to assess the independent prognostic value of primary tumor mitotic rate compared with other clinical and pathologic features of stages I and II melanoma. Methods From the American Joint Committee on Cancer (AJCC) melanoma staging database, information was extracted for 13,296 patients with stages I and II disease who had mitotic rate data available. Results Survival times declined as mitotic rate increased. Ten-year survival ranged from 93% for patients whose tumors had 0 mitosis/mm(2) to 48% for those with >= 20/mm(2) (P < .001). Mean number of mitoses/mm(2) increased as the primary melanomas became thicker (1.0 for melanomas <= 1 mm, 3.5 for 1.01 to 2.0 mm, 7.3 for 3.01 to 4.0 mm, and 9.6 for > 8 mm). Ulceration was also associated with a higher mitotic rate; 59% of ulcerated melanomas had >= 5 mitoses/mm(2) compared with 16% of nonulcerated melanomas (P < .001). In a multivariate analysis of 10,233 patients, the independent predictive factors for survival in order of statistical significance were as follows: tumor thickness (chi(2) = 104.9; P < .001), mitotic rate (chi(2) = 67.0; P < .001), patient age (chi(2) = 48.2; P < .001), ulceration (chi(2) = 46.4; P < .001), anatomic site (chi(2) = 34.6; P < .001), and patient sex (chi(2) = 33.9; P < .001). Clark level of invasion was not an independent predictor of survival (chi(2) = 3.2; P = .37). Conclusion A high mitotic rate in a primary melanoma is associated with a lower survival probability. Among the independent predictors of melanoma-specific survival, mitotic rate was the strongest prognostic factor after tumor thickness. J Clin Oncol 29: 2199-2205. (C) 2011 by American Society of Clinical Oncology
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