Kanaan Ziad, Mulhall Aaron, Mahid Suhal, Torres Marla L, McCafferty Michael, McMasters Kelly M, Hornung Carlton, Galandiuk Susan
Section of Colorectal Surgery, Department of Surgery, Price Institute of Surgical Research, University of Louisville School of Medicine, Louisville, Kentucky 40292, USA.
Am Surg. 2012 Jan;78(1):28-35.
Anal malignant melanoma (AMM) is a rare tumor with poor prognosis. We performed a systematic review of reports on wide local excision (WLE) and abdominoperineal resection (APR) for treatment of AMM in an attempt to define a precise set of reporting measures for outcomes of treatment of AMM. A systematic review of the literature was performed. Demographic data, surgical treatment, pathology, and survival rates were recorded. We compared WLE versus APR in terms of the overall survival time, the disease-free survival, and overall survival at 60 months. Twenty-one reports met the inclusion criteria. Notably, of these, 10 did not specify thickness of the primary melanoma. Interestingly, groin lymph node status was described in 19 of 21 reports, whereas location was specified in only 12 papers and thickness (depth in mm) in only 11. The median survival times of patients undergoing WLE (n = 324) and those undergoing APR (n = 369) are comparable (20 and 21 months, respectively). The mean median survival at 60 months was 15 per cent for WLE and 14 per cent for APR. The mean disease-free survival at 60 months was found to be 10 per cent for WLE and 6 per cent for APR. Patient selection for such a rare neoplasm yields very similar outcomes for both conservative and radical treatments. There is a wide variation in the reporting of both clinical and treatment outcomes. More uniformity of reporting of pathologic features and node status is essential before rational assessment of results can be done.
肛管恶性黑色素瘤（AMM）是一种预后较差的罕见肿瘤。我们对关于广泛局部切除（WLE）和腹会阴联合切除术（APR）治疗AMM的报告进行了系统评价，试图确定一套精确的AMM治疗结果报告指标。对文献进行了系统评价。记录了人口统计学数据、手术治疗、病理学和生存率。我们比较了WLE和APR在总生存时间、无病生存和60个月总生存方面的情况。21篇报告符合纳入标准。值得注意的是，其中10篇未明确原发性黑色素瘤的厚度。有趣的是，21篇报告中有19篇描述了腹股沟淋巴结状态，而仅12篇明确了肿瘤位置，仅11篇明确了厚度（毫米深度）。接受WLE（n = 324）和APR（n = 369）的患者的中位生存时间相当（分别为20个月和21个月）。WLE在60个月时的平均总生存率为 15%，APR为14%。WLE在60个月时的平均无病生存率为10%，APR为6%。对于这种罕见肿瘤，无论是保守治疗还是根治性治疗，患者选择产生的结果非常相似。临床和治疗结果的报告存在很大差异。在能够对结果进行合理评估之前，病理特征和淋巴结状态报告的更统一至关重要。
