黑色素瘤转移到远处部位与存活率降低和预后不良有关。除了目前用于黑色素瘤分期的 Breslow 厚度和溃疡之外，对可预测具有侵袭性生物学行为的肿瘤的其他临床病理学、皮肤镜和分子因素的研究至关重要。在 PubMed、Scopus、Cochrane 数据库和灰色文献直至 2023 年 11 月。观察性研究（包括队列和病例对照研究）包括原发性皮肤黑色素瘤的临床和组织病理学因素，以及远处转移 (DM) 和无远处转移生存 (DMFS) 的皮肤镜和分子预测因子进行了评估。首选随机效应模型，结果以风险比 (HR) 和 95% 置信区间 (CI) 表示，并且 I2 指数量化异质性。还进行了根据 AJCC 阶段的亚组分析和敏感性分析。定性和定量综合分别纳入了 143 项和 101 项研究。关于临床因素，与女性相比，男性以及与躯干相比，头颈部位置表现出更高的 DM 风险 [n=36，HR 1.49，95%CI 1.36 - 1.63，I2 33% 和 n=21，HR 1.24 ，95%CI 1.01 - 1.52，I2 62%]。这两个因素对 DMFS 的影响相似。 Breslow 厚度和溃疡是 DM 的重要预测因素。导致糖尿病风险增加的其他因素包括结节性（n=15，HR 2.51，95%CI 1.83 - 3.43，I2 56%）和恶性雀斑样痣亚型（n=12，HR 1.87，95%CI 1.27 - 2.75，I2） 0%），与浅表扩散亚型、淋巴血管侵犯（n=9，HR 2.05，95%CI 1.18 - 3.58，I2 78%）、SLN 阳性和 BRAF 突变状态相比。相反，回归是 DM 的阴性预测因子（n=15，HR 0.59，95%CI 0.44 - 0.79，I2 68%）。两项研究重点关注皮肤镜因素，发现色素沉着低和蓝白色面纱的存在可能预测 DM 的发展。尽管某些类别存在中度或高度异质性，但 I-II 期患者的亚组分析结果基本相似，敏感性分析未显示显着变化。肿瘤的临床和组织学特征以及皮肤镜特征和分子参数具有重要的预后意义信息并可以纳入模型中以预测具有高转移潜力的黑色素瘤。版权所有 © 2024 Elsevier B.V. 保留所有权利。

Melanoma metastasis to distant sites is associated with diminished survival rates and poor prognosis. Except of Breslow thickness and ulceration that are currently used in melanoma staging, the investigation of additional clinicopathological, dermatoscopic and molecular factors that could predict tumors with aggressive biologic behavior is of paramount importance.A literature search was conducted in PubMed, Scopus, Cochrane databases and gray literature until November 2023. Observational studies (including cohorts and case-control studies) were included and clinical and histopathological factors of primary cutaneous melanomas, along with dermatoscopic and molecular predictors of distant metastasis (DM) and distant metastasis-free survival (DMFS) were assessed. Random - effect models were preferred, the results were presented as Hazard Ratios (HRs) with 95 %Confidence Intervals (CIs) and the I2 index quantified heterogeneity. Subgroup analysis according to AJCC stage and sensitivity analysis were also conducted.One hundred forty-three and 101 studies were included in the qualitive and quantitative synthesis, respectively. Regarding clinical factors, males, compared to females, and head and neck location, compared to trunk, demonstrated higher risk for DM [n=36, HR 1.49, 95%CI 1.36 - 1.63, I2 33% and n=21, HR 1.24, 95 %CI 1.01 - 1.52, I2 62 %]. Both factors had similar effects on DMFS. Breslow thickness and ulceration were significant predictors or DM. Additional factors that posed an increased risk for DM were nodular (n=15, HR 2.51, 95 %CI 1.83 - 3.43, I2 56 %) and lentigo maligna subtypes (n=12, HR 1.87, 95 %CI 1.27 - 2.75, I2 0 %), compared to superficial spreading subtype, lymphovascular invasion (n=9, HR 2.05, 95 %CI 1.18 - 3.58, I2 78 %), SLN positivity and BRAF+ mutational status. In contrast, regression was a negative predictor of DM (n=15, HR 0.59, 95 %CI 0.44 - 0.79, I2 68 %). Two studies focused on dermatoscopic factors and found that low pigmentation and the presence of blue-white veil might predict DM development. The results of subgroup analysis for stage I-II patients were essentially similar and sensitivity analysis did not reveal significant alterations, despite the moderate or high heterogeneity in some categories.Clinical and histological characteristics of the tumor along with dermatoscopic features and molecular parameters hold significant prognostic information and could be incorporated into models to predict melanomas with high metastatic potential.Copyright © 2024 Elsevier B.V. All rights reserved.