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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
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皮肤原发性黑色素瘤的切除边缘为2厘米和4厘米:多中心随机试验的长期随访
Deborah Utjés1, Jonas Malmstedt2, Jüri Teras3
1Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Lancet (London, England)
|July 9, 2019
概括
对于厚皮黑色素瘤患者,切除边缘为2厘米是安全的,与近20年后的4厘米边缘相比,生存率没有差异. 这些发现支持在临床实践中对局部黑色素瘤使用更窄的边际.
科学领域:
- 癌症学
- 皮肤病学
- 外科瘤学
背景情况:
- 对于厚度 (> 2 mm) 的局部皮肤黑色素瘤,最佳的切除边缘仍然不确定.
- 之前的报告显示,在6. 7年的随访期间,2 厘米和4 厘米的生存率没有差异.
研究的目的:
- 提供延长的随访数据,以狭窄 (2厘米) 和宽 (4厘米) 的切除边缘治疗厚皮黑色素瘤患者的生存结果.
- 评估2厘米切割边缘的长期安全性和有效性.
主要方法:
- 一个多中心的随机对照试验,涉及936名患有厚型局部皮肤黑色素瘤的患者.
- 患者被随机分配到2厘米或4厘米的切除边缘.
- 延长后续分析了整体存活率和黑色素瘤特异性存活率.
主要成果:
- 随访时间中位数为19. 6年,死亡人数为621人 (2厘米组为304人,4厘米组为317人),总生存率没有显著差异 (HR为0. 98, p=0. 75).
- 397例死亡与黑色素瘤有关,在2厘米 (192例死亡) 和4厘米 (205例死亡) 组之间没有显著差异 (HR 0.95, p=0.61).
结论:
- 2厘米的切除边缘对于皮肤黑色素瘤患者来说是一个安全而有效的选择.
- 这些发现支持目前的临床实践,即对此类患者使用2厘米的切除边缘.
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