Excision margins and prognosis in cutaneous melanoma: retrospective population-based cohort study.

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2025-05-07 DOI:10.1093/bjsopen/zraf042
Alessandra Buja, Massimo Rugge, Chiara Trevisiol, Anna Zanovello, Luigi Dall'Olmo, Manuel Zorzi, Antonella Vecchiato, Paolo Del Fiore, Matteo Paiola, Carlo Riccardo Rossi, Simone Mocellin
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Abstract

Background: The impact of surgical excision margin size on the survival of patients with cutaneous melanoma (CM) is controversial. The aim of this study was to assess the impact of excision margins on patient outcomes.

Methods: This retrospective population-based follow-up study analysed data from patients presenting with CM without extranodal disease. The linear distance of CM from the excision margin was assessed microscopically. Regarding overall and melanoma-specific survival estimates, Kaplan-Meier analysis, the Cox proportional hazards model, and the subdistribution hazard ratio of the Fine-Gray model were applied.

Results: Of 3262 patients, a total of 2698 (82.7%) with pathological (p) T1-2 and 564 (17.3%) with pT3-4 CM underwent wide local excision. Multivariable analyses, adjusting for melanoma incidence cohort, age, sex, anatomical site, ulceration, histotype, mitotic count, and tumour-infiltrating lymphocytes, demonstrated that, in pT1-2 CM, surgical excision > 1.1 cm resulted in significant CM-specific survival benefit. In pT4 disease, a CM distance to the surgical margins of < 1.6 cm significantly lowered CM-specific survival.

Conclusion: This population-based study conducted in real-world clinical practice found that the prognosis of patients with pT1-2 CM may benefit from excision margins > 1.1 cm. In pT3-4 CM, margins < 1.6 cm were significantly associated with lower CM-specific survival rates. These findings highlight the need for further prospective studies to evaluate the safety of surgical excision margins in managing primary CM.

皮肤黑色素瘤的切除边缘和预后:基于人群的回顾性队列研究
背景:手术切除边缘大小对皮肤黑色素瘤(CM)患者生存的影响是有争议的。本研究的目的是评估切除边缘对患者预后的影响。方法:这项基于人群的回顾性随访研究分析了无结外疾病的CM患者的数据。显微镜下评估CM与切除缘的线性距离。对于总体和黑色素瘤特异性的生存估计,应用Kaplan-Meier分析、Cox比例风险模型和Fine-Gray模型的亚分布风险比。结果:在3262例患者中,病理(p) T1-2的患者共2698例(82.7%),pT3-4 CM的患者共564例(17.3%)行了广泛的局部切除。多变量分析,调整黑色素瘤发病率队列,年龄,性别,解剖部位,溃疡,组织型,有丝分裂计数和肿瘤浸润淋巴细胞,表明,在pT1-2 CM中,手术切除bb0 1.1 CM导致显著的CM特异性生存获益。在pT4疾病中,CM到手术缘的距离< 1.6 CM显著降低CM特异性生存率。结论:在现实世界的临床实践中进行的基于人群的研究发现,pT1-2 CM患者的预后可能受益于切除边缘bb0 - 1.1 CM。在pT3-4 CM中,切缘< 1.6 CM与较低的CM特异性生存率显著相关。这些发现强调需要进一步的前瞻性研究来评估手术切除边缘治疗原发性CM的安全性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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