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过去20年来皮肤恶性黑色素瘤的发生率每以5%的速度增长.根据美国癌肿学会统计,1995年约有7200例黑色素瘤病人死于转移,估计今后十年将有7万人死于此病.原发性皮肤黑色素瘤<0.75mm者的10年生存率可达95%,至于伴远处转移,即AJCCⅣ期病灶的生存率统计报告很少,John Wayne癌肿研究所分析1521例AJCCⅣ期黑色素瘤,对10个临床和病理变数进行了单因素和多因素分析.结果 初次诊治时,1134例为AJCCⅠ/Ⅱ期,358例隔19.8月后转为Ⅲ期,再隔9个月转为Ⅳ;362例原为Ⅲ期,隔12.6月后转为Ⅳ期;25例就诊时已属Ⅳ期.全组生存期中位值为7.5月,预计5年生存率为6%.(一)单因素分析 (1)年龄和性别:中位值年龄51岁(9～98岁),年龄与生存率不相关.61%为男性,女性的预后较好,但与绝经期前后无关.(2)原发灶部位:73%在肢体以外的部位,部位与预后不相关.(3)病灶厚度:是一预后因素,中位值厚度为2.0mm,而Ⅰ/Ⅱ期(Clark水平或Breslow深度)为<0.75mm.(4)诊断时年份:近20年虽有新疗法的开展,但治疗结果未见改善.(5)首个远处转移灶:肺占31%,皮肤和淋巴结占18%,14%就诊时已有多个转移灶.首个转移灶的部位决定随后的生存,肝、骨和脑转移者的生存期比皮肤、淋巴结和胃
The incidence of cutaneous melanoma in the past 20 years has increased at a rate of 5%. According to the American Cancer Society, approximately 7,200 melanoma patients died of metastasis in 1995. It is estimated that 70,000 people will die in the next decade. Disease. Primary skin melanoma <0.75mm 10-year survival rate of up to 95%, as with distant metastasis, the survival rate of AJCC stage IV report is rarely reported, John Wayne Cancer Institute analysis of 1521 cases of AJCCIV Stage melanoma, 10 clinical and pathological variables were analyzed by univariate and multivariate analysis. The results of the initial diagnosis and treatment, 1134 cases of AJCCI / II period, 358 cases after the interval of 19.8 months to III stage, and then every 9 months For IV; 362 cases were originally stage III and were switched to stage IV after 12.6 months; 25 cases were stage IV. The median survival time for the whole group was 7.5 months, and the 5-year survival rate was estimated to be 6%. (I) Univariate analysis (1) Age and sex: Median age was 51 years old (9 to 98 years old). Age was not related to survival rate. 61% were male. Women had a better prognosis, but were not related to menopause. (2 ) Primary site: 73% outside the limb, not related to prognosis. (3) Thickness of the lesion: a prognostic factor with a median thickness of 2.0 mm, and I/ Period (Clark level or Breslow depth) is <0.75 mm. (4) Year of diagnosis: In the past 20 years, although new therapies have been carried out, there is no improvement in treatment results. (5) First distant metastasis: 31% of lungs %, skin and lymph nodes accounted for 18%, 14% had multiple metastases at the time of the visit. The location of the first metastasis determines the subsequent survival, liver, bone and brain metastasis than the skin, lymph nodes and stomach