Περίληψη:
Background: Nodular melanoma (NM) is more likely to be fatal compared
with other melanoma subtypes, an effect attributed to its greater
Breslow thickness.
Methods: Clinicopathological features of NM and superficial spreading
melanoma (SSM) diagnosed in 17 centers in Europe (n = 15), the United
States, and Australia between 2006 and 2015, were analyzed by
multivariable logistic regression analysis, with emphasis on thin (T1 <=
1.0mm) melanomas. Cox analysis assessed melanoma-specific survival. All
statistical tests were two sided.
Results: In all, 20 132 melanomas (NM: 5062, SSM: 15 070) were included.
Compared with T1 SSM, T1 NM was less likely to have regression (odds
ratio [OR] = 0.46, 95% confidence interval [CI] = 0.29 to 0.72) or
nevus remnants histologically (OR = 0.60, 95% CI = 0.42 to 0.85), and
more likely to have mitoses (OR = 1.97, 95% CI = 1.33 to 2.93) and
regional metastasis (OR = 1.77, 95% CI = 1.02 to 3.05). T1 NM had a
higher mitotic rate than T1 SSM (adjusted geometric mean = 2.2, 95% CI
= 1.9 to 2.5 vs 1.6, 95% CI = 1.5 to 1.7 per mm(2), P < .001). Cox
multivariable analysis showed a higher risk for melanoma-specific death
for NM compared with SSM for T1 (HR = 2.10, 95% CI = 1.24 to 3.56) and
T2 melanomas (HR = 1.30, 95% CI = 1.01 to 1.68), and after accounting
for center heterogeneity, the difference was statistically significant
only for T1 (HR = 2.20, 95% CI = 1.28 to 3.78). The NM subtype did not
confer increased risk within each stratum (among localized tumors or
cases with regional metastasis).
Conclusions: T1 NM (compared with T1 SSM) was associated with a
constellation of aggressive characteristics that may confer a worse
prognosis. Our results indicate NM is a high-risk melanoma subtype that
should be considered for inclusion in future prognostic classifications
of melanoma.
Συγγραφείς:
Dessinioti, Clio
Dimou, Niki
Geller, Alan C.
Stergiopoulou,
Aravella
Lo, Serigne
Keim, Ulrike
Gershenwald, Jeffrey E.
and Haydu, Lauren E.
Ribero, Simone
Quaglino, Pietro
Puig,
Susana
Malvehy, Josep
Kandolf-Sekulovic, Lidija
Radevic,
Tatjana
Kaufmann, Roland
Meister, Laura
Nagore, Eduardo and
Traves, Victor
Champsas, Grigorios G.
Plaka, Mihaela
Dreno,
Brigitte
Varey, Emilie
Moreno Ramirez, David
Dummer,
Reinhard
Mangana, Joanna
Hauschild, Axel
Egberts, Friederike
and Peris, Ketty
del Regno, Laura
Forsea, Ana-Maria
Zurac,
Sabina A.
Vieira, Ricardo
Brinca, Ana
Zalaudek, Iris and
Deinlein, Teresa
Linos, Eleni
Evangelou, Evangelos
Thompson,
John F.
Scolyer, Richard A.
Garbe, Claus
Stratigos,
Alexander J.
