摘要目的 分析皮肤原发恶性黑色素瘤中细胞增殖活性与其他临床病理学参数的关系及预后意义,并筛选黑色素瘤的独立预后因素.方法 收集北京肿瘤医院资料完整的皮肤原发恶性黑色素瘤127例,采用免疫组织化学EnVision法检测肿瘤的Ki-67表达,参照第7版美国癌症联合会推荐的“热点”法计数肿瘤细胞的核分裂象,分析Ki-67表达水平、核分裂象数与其他临床病理参数的相关性,并结合随访资料对所有参数(包括TNM分期、Clark分级等)进行生存分析,筛选出影响患者生存预后的因素.结果 Ki-67表达水平与坏死、Breslow厚度相关(P＜0.05),核分裂象数与Clark分级及Ki-67表达水平相关(P＜0.05)；单因素分析显示Ki-67表达水平(P=0.043)、核分裂象数(P =0.030)和TNM分期(P＜0.001)可以影响黑色素瘤患者总生存,而多因素分析显示只有TNM分期(P ＜0.001)是影响总生存的独立预后因素.结论 初诊时TNM分期是影响皮肤原发黑色素瘤患者预后的最重要因素,Ki-67表达水平与核分裂象数是皮肤原发黑色素瘤重要的临床病理学参数.

abstractsObjective To investigate the correlations among Ki-67 expression,mitosis and other clinicopathological parameters of primary cutaneous malignant melanoma,and search for prognostic factors of malignant melanoma.Methods Totally 127 cases of primary cutaneous malignant melanoma were collected from Beijing Cancer Hospital.Immunohistochemical study for Ki-67 was performed,and the mitosis was calculated referring to “ hot spot” method recommended by the seventh edition of the American Joint Committee on Cancer (AJCC) melanoma staging system.The correlations of Ki-67 expression,mitosis and other clinicopathological parameters were analyzed,and the survival analysis of all these risk factors including TNM and Clark level was conducted based on follow up data.Results The expression level of Ki-67 was associated with necrosis and Breslow thickness (P ＜ 0.05).Mitosis was correlated with Clark level and Ki-67 expression (P ＜ 0.05).Univariate analysis indicated Ki-67 expression level (P =0.043),mitosis (P =0.030) and TNM stage (P ＜ 0.001) might influence the survival of patients.However,multivariate analysis showed that the TNM staging was the only independent prognostic factor affecting survival.Conclusions The prognosis of patients with primary cutaneous malignant melanoma was closely related to the TNM staging at the fist examination.Ki-67 expression and mitosis are two important clinicopathological parameters of primary cutaneous malignant melanoma.