黏膜黑色素瘤转移的自然史和模式：706 例前瞻性随访患者的分析。

The natural history and patterns of metastases from mucosal melanoma: an analysis of 706 prospectively-followed patients.

机构信息

Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.

Department of Melanoma, Yunnan Cancer Hospital, Kunming, China.

出版信息

Ann Oncol. 2017 Apr 1;28(4):868-873. doi: 10.1093/annonc/mdw694.

DOI:10.1093/annonc/mdw694

PMID:28039178

Abstract

BACKGROUND

We examined whether mucosal melanomas are different in their clinical course and patterns of metastases when arising from different anatomic sites. Our hypothesis was that metastatic behavior would differ from primary mucosal melanomas at different anatomical sites.

PATIENTS AND METHODS

Clinical and pathological data from 706 patients were compared for their stage distribution, patterns of metastases, CKIT/BRAF mutation status, and overall survival for different anatomical sites.

RESULTS

The anatomic sites of the primary mucosal melanomas were from the lower GI tract (26.5%), nasal cavity and paranasal sinuses (23%), gynecological sites (22.5%), oral cavity (15%), urological sites (5%), upper GI tract (5%), and other sites (3.0%). At initial diagnosis, 14.5% were stage I disease, 41% Stage II, 21.5% Stage III, and 23.0% stage IV. Predominant metastatic sites were regional lymph nodes (21.5%), lung (21%), liver (18.5%), and distant nodes (9%). Oral cavity mucosal melanoma had a higher incidence of regional nodal metastases (31.7% versus 19.8%, P = 0.009), and a higher incidence of lung metastases (32.5% versus 18.5%, P = 0.007) compared to other primary mucosal melanomas. There was a 10% incidence of CKIT mutation and 12% BRAF mutation. Mucosal melanomas from nasal pharyngeal and oral, gastrointestinal, gynecological, and urological had a similar survival with a 1-year survival rate (88%, 83%, 86%), 2-year survival rate (66%, 57%, 61%), 5-year survival rate (27%, 16%, 20%), respectively.

CONCLUSIONS

The largest sample size allows, for the first time, a comparison of primary melanoma stage and patterns of metastases across anatomical sites. With few exceptions, the presenting stages, incidence of nodal and distant metastases, the site of predilection of distant metastases, or overall survival were similar despite different primary anatomic sites. These findings suggest that clinical trials involving mucosal melanomas and the administration of systemic therapy can be applied equally to mucosal melanomas regardless of their primary anatomic site.

摘要

背景

我们研究了黏膜黑色素瘤从不同解剖部位起源时，其临床过程和转移模式是否存在差异。我们的假设是，不同解剖部位的原发性黏膜黑色素瘤的转移行为会有所不同。

方法

比较了 706 例患者的临床和病理数据，以比较其分期分布、转移模式、CKIT/BRAF 突变状态和不同解剖部位的总生存率。

结果

原发性黏膜黑色素瘤的解剖部位为下胃肠道（26.5%）、鼻腔和鼻旁窦（23%）、妇科部位（22.5%）、口腔（15%）、泌尿系统（5%）、上胃肠道（5%）和其他部位（3.0%）。初诊时，14.5%为 I 期疾病，41%为 II 期，21.5%为 III 期，23%为 IV 期。主要转移部位为区域淋巴结（21.5%）、肺（21%）、肝（18.5%）和远处淋巴结（9%）。口腔黏膜黑色素瘤区域淋巴结转移的发生率较高（31.7%比 19.8%，P=0.009），肺转移的发生率也较高（32.5%比 18.5%，P=0.007）。CKIT 突变发生率为 10%，BRAF 突变发生率为 12%。鼻咽喉和口腔、胃肠道、妇科和泌尿系统的黏膜黑色素瘤具有相似的生存率，1 年生存率（88%、83%、86%）、2 年生存率（66%、57%、61%）、5 年生存率（27%、16%、20%）。