肛管直肠恶性黑色素瘤38例临床分析

目的 通过对肛管直肠恶性黑色素瘤患者的临床病理特征、诊断治疗及生存预后进行分析,规范手术方式,探讨综合治疗模式.方法 回顾性分析38例经手术治疗的肛管直肠恶性黑色素瘤患者的临床病理资料,分析其与预后的相关性.结果 本组38例患者中,男10例,女28例,平均年龄58.7岁（28～75岁）,行腹会阴联合切除术28例,局部扩大切除术10例.1、3、5年无病生存率分别为64.9％、18.5％、5.7％,1、3、5年总生存率分别85.8％、24.1％、6.4％.肿瘤厚度≥1.51 mm、肿瘤直径≥3 cm与淋巴结转移相关（x2值分别为13.093、4.449;P值分别为0.011、0.020）,且肿瘤厚度亦与远处转移相关（χ^2=11.965,P=0.018）.单因素分析显示,术后辅助治疗与无病生存相关（χ^2=7.441,P=0.006）;肿瘤厚度、淋巴结转移、临床分期与总生存相关（χ^2值分别为16.741、16.474、16.775;P值分别为0.002、0.000、0.000）.多因素分析显示,术后辅助治疗为无病生存的独立危险因素（95％CI 1.420～17.621,P=0.012）;肿瘤厚度、淋巴结转移为总生存的独立危险因素（95％ CI 0.250～0.949,P=0.035;95％ CI 1.033～2.573,P=0.036）.结论 早期诊断、合理选择手术方式、重视免疫治疗的多学科协作诊疗是提高肛管直肠恶性黑色素瘤患者生存质量、延长生存期的关键.

Clinical analysis of 38 patients with anorectal malignant melanoma

Objective To investigate the diagnosis and treatment of anorectal malignant melanoma,in order to regulate surgical methods and explore multi-modality treatment.Methods Clinical pathological features,diagnosis and treatment procedures of 38 patients with anorectal melanoma were reviewed,and their correlation with prognosis were analyzed.Results In 38 patients,10 of them were male and 28 were female,with the mean age of 58.7 years old （ranged 28-75 years old）.28 patients underwent abdominoperineal resection,10 patients underwent wide local excision.The 1-,3-,and 5-year disease-free survival rates were 64.9 %,18.5 % and 5.7 %,respectively.The 1-,3-,and 5-year overall survival rates were 85.8 %,24.1% and 6.4 %,respectively.Tumor thickness （≥ 1.51 rm） and tumor diameter （≥3 cm） were associated with lymph metastases （χ^2 =13.093,4.449,P =0.011,0.020）,tumor thickness was also associated with distant metastases （χ^2 =11.965,P =0.018）.According to the Kaplan-Meier method,comprehensive treatment after surgery had significant effects on disease-free survival （x2 =7.441,P =0.006）.Tumor thickness,lymph metastases,and clinical staging had significant effects on overall survival （χ^2 =16.741,16.474,16.775,P =0.002,0.000,0.000）.Cox proportional hazards model indicated that comprehensive treatment after surgery was the independent prognostic risk factors of disease-free survival （95 % CI 1.420-17.621,P =0.012）.Tumor thickness and lymph metastases were the independent prognostic risk factors of overall survival （95 % CI 0.250-0.949,1.033-2.573,P =0.035,0.036）.Conclusion Early detection,reasonable surgical procedure,generalized systemic focus on immunotherapy treatment are the key to improve quality of life and prolong the survival time of anorectal malignant melanoma patients.