Shuman Andrew G, Light Emily, Olsen Stephen H, Pynnonen Melissa A, Taylor Jeremy M G, Johnson Timothy M, Bradford Carol R
Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
Arch Otolaryngol Head Neck Surg. 2011 Apr;137(4):331-7. doi: 10.1001/archoto.2011.46.
To identify significant clinical and pathological predictors of survival in mucosal melanoma of the head and neck.
Retrospective case series. We reviewed cases of mucosal melanoma of the head and neck from a prospectively collected database after institutional review board approval.
A single academic institution.
Fifty-two patients with mucosal melanoma of the head and neck.
With a median follow-up of 97 months, the median overall survival was 52 months, with a 5-year overall survival of 38%. The median disease-free survival was 15 months, with a 5-year disease-free survival of 22%. Younger age (P = .02), lower T status (P = .003), and lower American Joint Committee on Cancer stage (P < .001) were associated with better overall survival. Positive surgical margins predicted poorer overall survival (P = .01), but patients who required reexcision to achieve negative margins had outcomes that were not significantly different from those with initially negative surgical margins (P = .71). Sex, smoking history, and primary site did not affect disease-free or overall survival. Adjuvant radiotherapy and/or chemotherapy did not predict improved outcomes. Fewer mitoses (P = .02) and the absence of ulceration (P = .01) predicted improved overall survival.
Our experience confirms the utility of current staging systems in predicting outcomes of mucosal melanoma of the head and neck and stresses the importance of achieving negative surgical margins. Pathologically, fewer mitoses and the absence of ulceration predict better outcomes and should be reported as part of routine histological profiles of mucosal melanoma. Further studies are necessary to change the paradigm of care for this rare and deadly disease.
确定头颈部黏膜黑色素瘤生存的重要临床和病理预测因素。
回顾性病例系列研究。经机构审查委员会批准后，我们从一个前瞻性收集的数据库中回顾了头颈部黏膜黑色素瘤病例。
一家学术机构。
52名头颈部黏膜黑色素瘤患者。
中位随访时间为97个月，中位总生存期为52个月，5年总生存率为38%。中位无病生存期为15个月，5年无病生存率为22%。年龄较小（P = 0.02）、较低的T分期（P = 0.003）和较低的美国癌症联合委员会分期（P < 0.001）与较好的总生存期相关。手术切缘阳性预示总生存期较差（P = 0.01），但需要再次切除以获得阴性切缘的患者的预后与初始手术切缘阴性的患者无显著差异（P = 0.71）。性别、吸烟史和原发部位不影响无病生存期或总生存期。辅助放疗和/或化疗不能预测预后改善。有丝分裂较少（P = 0.02）和无溃疡（P = 0.01）预示总生存期改善。
我们的经验证实了当前分期系统在预测头颈部黏膜黑色素瘤预后方面的实用性，并强调了获得阴性手术切缘的重要性。在病理上，有丝分裂较少和无溃疡预示着较好的预后，应作为黏膜黑色素瘤常规组织学特征的一部分进行报告。需要进一步研究以改变这种罕见且致命疾病的治疗模式。
