胃肠道恶性黑色素瘤70例临床分析

目的 探讨胃肠道恶性黑色素瘤的诊治方法,提高诊治水平.方法 总结1965年7月至2007年6月收治的70例胃肠道恶性黑色素瘤患者的临床资料.结果 70例患者中男性27例,女性43例,年龄25～75岁,中位年龄53岁,其中50例发生于直肠,10例发生于肛管,10例发生于食管.1、3、5年生存率分别为48.3%、14.6%、6.5%,中位生存时间为379 d.63例接受手术治疗,单纯手术的25例患者和术后辅助化疗、放疗、生物治疗等综合治疗的38例患者的总生存率无统计学差异,Ⅲ期患者综合治疗组较单纯手术组生存率显著升高.风险因素分析提示病变深度为胃肠道恶性黑色素瘤的危险因素.结论 手术加综合治疗能提高Ⅲ期胃肠道恶性黑色素瘤的生存率;病变深度是影响生存率的风险因素.

Outcome of malignant melanoma in gastrointestinal tract: clinical analysis of 70 cases

OBJECTIVE: To investigate the diagnosis and treatments of malignant melanoma in gastrointestinal tract. METHOD: The clinical data of 70 cases of malignant melanoma in gastrointestinal tract treated between July 1965 and June 2007 were collected and analyzed. RESULTS: There were 27 male and 43 female patients in this group with a median age of 53 years. The melanoma arose from rectum in 50 cases, from anus in 10 cases and from esophagus in 10 cases. The overall 1, 3, 5 years survival rate were 48.3%, 14.6% and 6.5%, respectively, the median survival time was 379 days. Sixty-three cases received operations with or without adjuvant therapy after the operation. There was no significant differences in overall survival rate between the 25 cases received operation only (Group 1) and 38 cases supplemented by adjuvant therapy after operation (Group2); whereas, the cases with clinical stage III tumor in Group 2 had significantly better survival than their counterparts in Group 1. It was found that the depth of tumor invasion was the risk factor of patient's prognosis on multivariate Cox regression analysis. CONCLUSIONS: Operation combined with adjuvant therapy can improve the survival of the patient with stage III melanoma in gastrointestinal tract. The depth of tumor invasion is a risk factor of survival in these patients.