原发鼻腔鼻窦黏膜恶性黑色素瘤94例临床分析

目的 探讨鼻腔鼻窦黏膜恶性黑色素瘤的进展规律及疗效。方法 回顾分析2000—2012年间94例鼻腔鼻窦黑色素瘤资料。男50例、女44例,发病年龄26~85岁(中位数60岁)。原发鼻腔86例、上颌窦7例、鼻咽部1例。颈部淋巴结转移10例(7例疗前、2例疗中、1例疗后),无远处转移。采用手术±放疗方法。采用Kaplan-Meier法计算生存率并Logrank法单因素预后分析,Cox模型多因素预后分析。结果 全组1、3、5年样本数量分别为80、54、50例,1、3、5年疾病相关生存率分别为71%、33%、22%。单因素分析发现影响预后因素为年龄>55岁(P=0.034)、累及后鼻孔(P=0.011)、累及上颌窦(P=0.009)、累及硬腭(P=0.003)、颈部淋巴结转移(P=0.001)、治疗方式(P=0.038)。多因素分析发现影响预后因素为累及后鼻孔(P=0.027)、累及眼眶(P=0.005)、累及硬腭(P=0.003)。结论 鼻腔鼻窦黏膜恶性黑色素瘤的远处转移和局部复发率较高,需多学科多手段联合治疗;颈部淋巴结转移率较低;临床分期的合理性有待进一步研究。

Characteristics and prognosis of primary mucosal melanoma of nasal cavity and paranasal sinuses: a clinical analysis of 94 patients

Objective To investigate the clinical features and survival status of mucosal melanoma of the nasal cavity and paranasal sinuses and to analyze the prognostic factors. Methods A retrospective analysis was performed on the clinical data of 94 patients with mucosal melanoma of the nasal cavity and paranasal sinuses treated from January 2000 to December 2012. Of the 94 patients, 50 were male, and 44 were female. The median age of onset was 60 years (range, 26-85 years). The primary sites were nasal cavity (86 patients), maxillary sinus (7 patients), and nasopharynx (1 patient). Cervical lymph node metastasis was observed in 10 patients (7 patients before treatment, 2 patients during treatment, and 1 patient after treatment).No patient had distant metastasis.Patients were treated with surgery ± radiotherapy. The Kaplan-Meier method was used to calculate survival rates, and the logrank test was used for univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis. Results The 1-, 3-, and 5-year sample sizes were 80, 54, and 50, respectively. The 1-, 3-, and 5-year disease-related survival rates were 71%, 33%, and 22%, respectively. Univariate analysis showed that the prognostic factors were age over 55 years (P=0.034), involvement of the posterior naris (P=0.011), involvement of the maxillary sinus (P=0.009), involvement of the hard palate (P=0.003), cervical lymph node metastasis (P=0.001), and therapeutic method (P=0.038). Multivariate analysis showed that the prognostic factors were involvement of the posterior naris (P=0.027), involvement of the orbit (P=0.005), and involvement of the hard palate (P=0.003). Conclusions The distant metastasis and local recurrence rates are high among patients with mucosal melanoma of the nasal cavity and paranasal sinuses, so combination therapy is imperative. Cervical lymph node metastasis rate is low. Rational clinical staging needs to be further explored.