原发性鼻黏膜及口腔黏膜恶性黑色素瘤患者的预后因素分析

目的:总结手术治疗的原发性鼻黏膜及口腔黏膜恶性黑色素瘤患者的临床特点及生存状况,探讨影响其预后的主要因素。方法:回顾性分析1980-01-2005-01期间66例原发性鼻黏膜及口腔黏膜的恶性黑色素瘤患者的临床资料,复习病历并进行随访。生存分析采用Kaplan-Meier法,多因素分析采用Cox模型。结果:66例患者中,37例行术后辅助治疗,包括化疗12例,生物治疗8例,化疗加生物治疗5例,放疗8例,放疗加化疗4例。15例(22.7%)首次治疗后6个月内原发灶复发或伴淋巴结转移或远处转移。10例(15.2%)出现远处转移。平均生存时间为77.9个月,中位生存时间为33.7个月,3年和5年累积生存率分别为41.4%和31.1%。多因素分析显示:肿瘤最长径、有无淋巴结转移、首次治疗效果是影响预后的独立因素。结论:原发性鼻黏膜及口腔黏膜的恶性黑色素瘤预后较差,生存率较低,局部复发率较高,且容易出现淋巴结转移及远处转移。影响预后的独立因素是肿瘤大小、有无淋巴结转移和首次治疗效果。关于术后辅助治疗的作用仍需进一步研究。

Analysis of prognostic factors of primary mucosal melanoma in nasal and oral cavity

Objective:Primary mucosal melanoma of nasal and oral cavity is a rare tumor with a poor prognosis.This study aims to summarize the clinical features and survival status and then to evaluate the prognostic factors.Method:Clinical data of 66 patients with mucosal melanoma in nasal and oral cavity treated from Jan.1980 to Jan.2005,were retrospectively reviewed.All patients received the surgery.The following parameters: gender,age,primary location,tumor size,presence of ulcer,presence of pigment aggradation,lymph node metastasis,treatment mode and initially treatment outcome were investigated to evaluate their potential impact on survival.Kaplan-Meier method and Log-rank test were used for survival analysis.Cox proportional hazards regression was used for multivariate analysis.Result:The primary locations were nasal cavity(34 cases),oral cavity(23 cases) and paranasal sinuses(9 cases).All patients received surgery.Thirty-seven patients received post-operative adjuvant treatments.Of which,12 received adjuvant chemotherapy,8 received adjuvant immumotherapy,5 received adjuvant chemotherapy and immunotherapy,8 received adjuvant radiotherapy and 4 received adjuvant radiotherapy and chemotherapy.Local recurrence,lymph node metastasis or distant metastasis appeared in 15 patients at 6 months after the primary treatment.The distant metastasis rate was 15.2%(10/66).The average survival time was 77.9 months,the median survival time was 33.7 months.The 3-year and 5-year overall survival rates were 41.4% and 31.1% respectively.Multivariate analysis showed that tumor size,lymph node metastasis and inintially treatment outcome were significant prognostic factors for overall survival.Conclusion:The prognosis of mucosal melanoma in nasal and oral cavity is poor.Tumor size,lymph node metastasis,initially treatment outcome are independent prognostic factors for overall survival.The effect of post-operative adjuvant treatments is not clear,and further studies are needed.