212例中国粘膜黑色素瘤患者的临床病理及预后分析

目的 分析粘膜黑色素瘤患者的临床表现、病理及预后情况。方法 收集2006年1月至2011年3月经病理确诊的212例粘膜黑色素瘤患者的临床病理资料，采用AJCC第7版黑色素瘤分期，并对其生存情况进行随访，用Kaplan-Meier法进行生存分析及Cox回归模型进行生存预测的多因素分析。结果 212例粘膜黑色素瘤患者的平均年龄为55.8岁，男女性别比为1∶1.46，头颈部是最常见的原发部位（45.3％），出血是就诊时最常见的症状（40.6％）。49.5％的患者就诊时原发灶存在明确的镜下溃疡，原发灶中位浸润深度为3.8mm（0.6～16.0mm）。就诊时不同分期所占比例分别为：Ⅰ、Ⅱ期 64.6％，Ⅲ期 23.6％，Ⅳ期 11.8％。肺是最常见的远处转移部位（55.2％）。最主要的治疗方式仍为手术治疗。212例患者的1、2、5年生存率分别为83.7%、68.3％和26.1％，中位总生存时间为33.0个月（95％ CI：22.9～43.1个月）。多因素分析显示，就诊时分期与血清乳酸脱氢酶（LDH）是影响总生存时间的独立预后因素，术后辅助治疗和LDH是影响无病生存时间的独立预后因素。结论头颈部是粘膜黑素瘤最常见的原发部位，半数粘膜黑色素瘤患者就诊时原发灶存在溃疡并伴有较深的肿瘤浸润。就诊时分期与患者的总生存时间显著相关，术后辅助治疗可改善Ⅰ～Ⅲ期患者的无病生存时间。

Clinical presentation, histology and prognosis of mucosal melanoma in ethnic Chinese: A study of 212 consecutive cases

Objective To determine the clinical presentation and outcome of patients with mucosal melanoma in China.Methods The elements of the database included basic demographic data of patients and prognosticators previously reported in literature,as well as the follow-up data including clinical outcome after treatment.The American Joint Committee on Cancer（AJCC） staging system（7th edition） was used for either clinical or pathological staging.Medical record of all patients with pathologically diagnosed mucosal melanoma consulted in our center since 2006 were retrieved and reviewed.Statistical analyses including survival and multivariate analyses of factors associated with survival were respectively performed by Kaplan-Meier method and Cox proportional hazard model.Results A total of 212 cases of mucosal melanoma were identified and reviewed.The mean age was 55.8 years with male-to-female ratio 1∶1.46.Head and neck was the most common site（45.3%）.Bleeding was the most common initial symptom（40.6%）.In their primary lesion,49.5% of patients had definitive ulceration with a median thickness 3.8mm（0.6-16.0mm）.Lung（55.2%） was the most common metastatic site.The mainstay of therapy for mucosal melanoma was still surgery.The 1-,2-and 5-year overall survival（OS） rates were 83.7%,68.3% and 26.1%,with a median OS of 33.0 months（95% CI： 22.9-43.1months）.The results of multivariate analysis indicated that stage at diagnosis and serum lactate dehydrogenase（LDH） level were two significant predictive factors for OS,while the application of adjuvant therapy and LDH were the independent factors influencing disease free survival（DFS）.Conclusion Head and neck was the most common primary site of mucosal melanoma.In their primary lesion half of patients had definitive ulceration and got a much thicker tumor invasion.Clinical staging was significantly associated with clinical outcome in terms of OS,and the use of adjuvant therapy could significantly improve the DFS of patients with stage Ⅰ-Ⅲ.