肛管直肠恶性黑色素瘤18例临床分析

[摘要] 目的 探讨恶性黑色素瘤根治性手术治疗的临床意义和影响预后的因素。方法 回顾性分析资料完整肛管直肠恶性黑色素瘤18例临床病理特点、手术方式、预后。 结果 肛管直肠恶性黑色素瘤临床上容易误诊,本组18例术前误诊为直肠癌6例。手术切除15例,其中Miles、术10例,经肛门肿瘤局部切除5例,改道手术3例。全组中位生存期18.1个月,5年生存率19. 1%。统计提示淋巴结转移是影响预后的因素（P = 0.008）,而手术方式、肿瘤色素、性别等与预后无关（P > 0.05）。结论 肛管直肠黑色素瘤是一种罕见、预后极差的恶性肿瘤,淋巴结转移是影响预后的重要因素,而不同手术切除方式与预后无关,何种术式的选择应根据不同肿瘤期别及个体情况而定。为降低复发、转移率,提高远期生存率,目前主张手术联合放、化疗,特别是免疫治疗的综合治疗。

Clinical analyses of anorectal melanoma in 18 patients

[ABSTRACT] BACKGROUND & OBJECTIVE: Anorectal melanoma is a rare disease among gastrointestinal malignancies, which has unique biological characteristics compared to other anorectal cancers and a very poor prognosis. No widely accepted standard surgical modality is established for anorectal melanoma. In order to evaluate the clinical significance of surgical treatments and the survival factors, the clinico-pathological data of 18 patients with anorectal melanoma in our Cancer Center were analyzed in the present study. METHODS: We performed a retrospective review of 18 patients with anorectal melanoma, who underwent surgical treatment in our Cancer Center between January 1975 and December 2007. The clinico-pathological data, and surgical modalities, and the prognoses were analyzed. Kaplan-Meier survival analyses were applied, and the log-rank tests were performed to evaluate the differences. RESULTS: Misdiagnosis frequently occurs in anorectal melanoma. In all of the 18 cases studied, 6 cases were misdiagnosed as rectal adenocarcinoma. Fifteen patients underwent surgery, with Miles、procedure was used in 10 patients, local resection was performed in 5 patients; palliative gastro-intestinal tract diversion was applied in 3 patients. The median survival of all patients was 18.1 months; the 5-year survival rate was 19.1%. The statistical analyses showed that the regional lymph node metastasis was the prognostic factor (P = 0.008), while none of the surgical modality, the pigmentation of the tumor, or the gender of the patient was prognostic factor (P > 0.05). CONCLUSION: Anorectal melanoma is a rare malignancy with very poor prognosis. The regional lymph node metastasis is an important prognostic factor, while the surgical modality had no significant correlation with the prognosis. The selection of the surgical modalities should be based on the staging of the tumor and the individual condition of the patient. In order to reduce the relapse rate and the metastasis rate, and to improve the long-term survival rate, the combination therapy including surgery, radiation therapy, chemotherapy, and particularly immunotherapy is currently suggested for the treatment of anorectal melanoma.