Long term results of a randomized study by the Swedish Melanoma Study Group on 2-cm versus 5-cm resection margins for patients with cutaneous melanoma with a tumor thickness of 0.8–2.0 mm

Autor: Cohn-Cedermark, Gabriella, Rutqvist, Lars Erik, Andersson, Ronny, Breivald, Mats, Ingvar, Christian, Johansson, Hemming, Jönsson, Per-Ebbe, Krysander, Lennart, Lindholm, Christer, Ringborg, Ulrik
Zdroj: Cancer; 1 October 2000, Vol. 89 Issue: 7 p1495-1501, 7p
Abstrakt: Large, prospective, randomized trials with long term follow-up are required to obtain an unbiased evaluation of the significance of resection margins in patients with cutaneous melanoma. The Swedish Melanoma Study Group performed a prospective, randomized, multicenter study of patients with primary melanoma located on trunk or extremities and with a tumor thickness > 0.8 mm and ≤ 2 mm. Patients were allocated randomly to a 2-cm excision margin or a 5-cm excision margin. In total, 989 patients were recruited during the period 1982–1991. The median follow-up was 11 years (range, 7–17 years) for estimation of survival and 8 years (range, 0–17 years) for evaluation of recurrent disease. The crude rate of local recurrence, defined as a recurrence in the scar or transplant, was < 1% (8 of 989 patients). Twenty percent of the patients (194 of 989 patients) experienced any disease recurrence, and 15% (146 of 989 patients) died of melanoma. There were no statistically significant differences between the two treatment arms. In a multivariate Cox analysis with patients allocated to wide excision as the reference group, the estimated relative hazards for overall survival and recurrence free survival among those allocated to a 2-cm resection margin were 0.96 (95% confidence interval, 0.75–1.24), and 1.02 (95% confidence interval, 0.80–1.30), respectively. In this long term follow-up study, local recurrences were found to be rare among patients with tumors > 0.8 mm thick and ≤ 2.0 mm thick. No difference in recurrence rate or survival between the two treatment groups was found. Patients in this category can be treated with a resection margin of 2 cm as safely as with a resection margin of 5 cm. Cancer 2000;89:1495–501. © 2000 American Cancer Society.
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