原发性宫颈及阴道恶性黑色素瘤51例的临床分析

背景与目的：原发性宫颈及阴道恶性黑色素瘤是一类罕见的、恶性程度高、预后极差的肿瘤。本研究旨在探讨原发性宫颈及阴道恶性黑色素瘤患者的临床特点、治疗方式及预后。方法：对复旦大学附属肿瘤医院1998年12月—2011年7月收治的51例宫颈及阴道恶性黑色素瘤患者的临床资料进行回顾性分析。结果：2、4年无进展生存率分别为32.8%、13.1%，2、4年总生存率分别为67.2%、39.8%，3例带瘤生存超过5年。随访期内，29例(56.9%)患者发生复发转移，主要部位为阴道残端/盆腔(10例，34.5%)、肝(4例，13.9%)、肺(3例，10.3%)、骨(3例，10.3%)和外阴(3例，10.3%)等。单因素分析显示，肿瘤大小和脉管癌栓是影响患者总体生存的重要因素(P＜0.05)，盆腔淋巴结转移是影响无进展生存的重要因素(P＝0.05)。术后联合放化疗和免疫治疗组中位疾病进展时间为17个月，而单纯化疗组为9个月，单纯免疫治疗组为11个月。结论：原发性宫颈及阴道恶性黑色素瘤预后差。手术、放化疗和免疫综合治疗具有控制疾病进展、延长患者生存的作用。

Prognosis of 51 patients with primary malignant melanomas of the cervix and vagina

Background and purpose: Primary malignant melanomas of the uterine cervix and vagina are rare neoplasms with very poor prognosis. This article aimed at investigating the clinicopathologic characteristics, treatment and prognosis of primary malignant melanomas of the cervix and vagina. Methods: The clinical data of 51 patients with primary malignant melanomas of the cervix and vagina treated at Fudan University Shanghai Cancer Center from Dec.1998 to Jul. 2011 were reviewed. Results: The 2- and 4-year progression-free survival (PFS) rates were 32.8% and 13.1%, respectively. The 2- and 4-year overall survival (OS) rates were 67.2% and 39.8%, respectively. Three patients survived more than 5 years. Twenty-nine (56.9%) patients had a recurrence. The common sites were vaginal stump/pelvis (10 patients, 34.5%), liver (4 patients, 13.9%), lung (3 patients, 10.3%), bone (3 patients, 10.3%) and vulva (3 patients, 10.3%). Larger tumor size and lymphovascular space invasion were the independent predictors of poor OS (P<0.05). Pelvic lymph nodes metastases were associated with shorter PFS (P=0.05). Among them, those who received combined immunotherapy and chemoradiotherapy achieved longer median time to progression (TTP) (17 months) compared with patients who had chemotherapy alone (9 months) or immunotherapy alone (11 months). Conclusion: Primary melanomas of cervix and vagina have a very poor prognosis. The multidisciplinary treatment of combining surgery, chemoradiotherapy, and immunotherapy can improve the patients’ prognosis.