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首页 » PLoS ONE报道 » PLoS Med:前哨淋巴结中癌细胞数量判断黑色素瘤预后

PLoS Med:前哨淋巴结中癌细胞数量判断黑色素瘤预后

来源:生物谷 2014-02-19 20:37

2014年2月19日讯 /生物谷BIOON/--近日,一项最新研究证实扩散到前哨淋巴结(淋巴结是癌细胞最有可能扩散转移到的部位)中的癌细胞数量多少可以预测恶性黑色素瘤患者的死亡风险。据德国Tübingen and Regensburg大学Anja Ulmer以及同事发表在本周PLOS Medicine杂志上的新研究中,病人的预后在很大程度上取决于扩散到前哨淋巴结中的肿瘤细胞数量。

皮肤疾病死亡的首要原因是黑色素瘤,黑色素瘤是最危险的皮肤癌类型。当黑色素瘤发生转移和扩散到身体的其他部位,治疗方案的选择变得有限,且患者预后较差。黑色素瘤分期(及预后)目前专注于原发肿瘤本身的特点,像肿瘤厚度,有丝分裂率和溃疡(肿瘤引起的皮肤破裂),这些特定预示肿瘤是否蔓延的可能性。

由于黑色素瘤是最致命的癌症之一,更好预测黑色素瘤患者预后的指标需要更多的信息,需要有标准程序衡量癌细胞如何蔓延到前哨淋巴结,以及如何将这些信息与肿瘤组织学进行整合。

研究人员前瞻性地收集了这种相对罕见癌症的大量样本:1,027例黑色素瘤患者的1,834例前哨淋巴结,这些患者在取样后一直被追访研究了5年。通过使用标记黑色素瘤细胞的标记,研究人员标记淋巴结中散散的癌细胞(DCCs),并计数它们,计算出DCC密度。然后,他们判断DCC密度是否与患者的生存期相关。他们发现,淋巴结高密度DCC患者更有可能在5年内死亡。DCC密度增加10倍的患者死亡风险几乎翻了一番。(生物谷Bioon.com)

 

Quantitative Measurement of Melanoma Spread in Sentinel Lymph Nodes and Survival

Ulmer A, Dietz K, Hodak I, Polzer B, Scheitler S, et al.

Background

Sentinel lymph node spread is a crucial factor in melanoma outcome. We aimed to define the impact of minimal cancer spread and of increasing numbers of disseminated cancer cells on melanoma-specific survival.

Methods and Findings

We analyzed 1,834 sentinel nodes from 1,027 patients with ultrasound node-negative melanoma who underwent sentinel node biopsy between February 8, 2000, and June 19, 2008, by histopathology including immunohistochemistry and quantitative immunocytology. For immunocytology we recorded the number of disseminated cancer cells (DCCs) per million lymph node cells (DCC density [DCCD]) after disaggregation and immunostaining for the melanocytic marker gp100. None of the control lymph nodes from non-melanoma patients (n = 52) harbored gp100-positive cells. We analyzed gp100-positive cells from melanoma patients by comparative genomic hybridization and found, in 45 of 46 patients tested, gp100-positive cells displaying genomic alterations. At a median follow-up of 49 mo (range 3–123 mo), 138 patients (13.4%) had died from melanoma. Increased DCCD was associated with increased risk for death due to melanoma (univariable analysis; p<0.001; hazard ratio 1.81, 95% CI 1.61–2.01, for a 10-fold increase in DCCD + 1). Even patients with a positive DCCD ≤3 had an increased risk of dying from melanoma compared to patients with DCCD = 0 (p = 0.04; hazard ratio 1.63, 95% CI 1.02–2.58). Upon multivariable testing DCCD was a stronger predictor of death than histopathology. The final model included thickness, DCCD, and ulceration (all p<0.001) as the most relevant prognostic factors, was internally validated by bootstrapping, and provided superior survival prediction compared to the current American Joint Committee on Cancer staging categories.

Conclusions

Cancer cell dissemination to the sentinel node is a quantitative risk factor for melanoma death. A model based on the combined quantitative effects of DCCD, tumor thickness, and ulceration predicted outcome best, particularly at longer follow-up. If these results are validated in an independent study, establishing quantitative immunocytology in histopathological laboratories may be useful clinically.

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