头颈部黏膜恶性黑色素瘤手术联合放疗的预后分析

目的 探讨头颈部黏膜恶性黑色素瘤手术联合放疗的综合治疗模式的效果和失败模式,并分析影响预后的因素。方法 回顾分析1982-2017年收治的194例无远处转移的头颈部黏膜恶性黑色素瘤患者的病历资料。分析综合治疗模式的效果、失败模式及预后影响因素。结果 全组患者5年总生存、无局部复发生存、无区域复发生存和无远处转移生存率分别为41.4%、57.8%、76.5%和46.5%。194例患者中治疗失败141例,失败率为74.6%,其中首次失败为远处转移的患者占40%(56/141),首次失败为局部失败的患者占37%(52/141),首次失败为区域失败的患者占15%(21/141),同时合并远处转移和局部失败的患者占5%(7/141),同时合并局部失败和区域失败的患者占3%(5/141)。Cox多因素结果显示手术切缘和联合放疗是影响局部控制的独立预后因素(P=0.001、P=0.000)。结论 头颈部黏膜恶性黑色素瘤手术联合放疗的综合治疗模式可以获得较好的局部控制率,远处转移仍是其主要失败模式。

Analysis of clinical efficacy,failure pattern and prognostic factors of comprehensive treatment for malignant mucosal melanoma of head and neck

Objective To evaluate the clinical efficacy,failure pattern and prognostic factors of the malignant mucosal melanoma of the head and neck (MMHN) in a single center. Methods The treatment pattern,clinical efficacy,failure pattern and prognostic factors of 194 M0 MMHN patients admitted to our institution from 1982 to 2017 were retrospectively analyzed. Results The 5-year overall survival (OS),local recurrence-free survival (LRFS),regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) were 41.4%,57.8%,76.5% and 46.5%,respectively. The failure rate was calculated as 74.6%(141/189).Among them,40%(56/141) had distant metastasis as the first pattern of treatment failure,37%(52/141) had local relapse,15%(21/141) had regional relapse,5%(7/141) had concurrent distant metastasis and local/regional relapse and 3%(5/141) had concurrent local and regional relapse. Multivariate analysis demonstrated that surgical margins (P=0.001) and adjuvant radiotherapy (P=0.000) were the independent prognostic factors for LRFS. Conclusions Surgery combined with radiotherapy can yield relatively high LRFS in the comprehensive treatment of MMHN.Distant metastasis is the major failure pattern.