Department of Dermatology and Allergy, Munich University Hospital (LMU), Frauenlobstr. 9-11, 80337 Munich, Germany.
Department of Dermatology, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany; German Cancer Consortium (DKTK), Germany.
Eur J Cancer. 2017 Aug;81:36-44. doi: 10.1016/j.ejca.2017.05.014. Epub 2017 Jun 7.
Mucosal melanoma (MM) is a rare but diverse cancer entity. Prognostic factors are not well established for Caucasians with MM.
We analysed the disease course of 444 patients from 15 German skin cancer centres. Disease progression was determined with the cumulative incidence function. Survival times were estimated with the Kaplan-Meier method. Prognostic parameters were identified with multivariate Cox regression analysis.
Common anatomic sites of primary tumours were head and neck (MMHN, 37.2%), female genital tract (MMFG, 30.4%) and anorectal region (MMAN, 21.8%). MMAN patients showed the highest vertical tumour thickness (p = 0.001), had a more advanced nodal status (p = 0.014) and a higher percentage of metastatic disease (p = 0.001) at diagnosis. Mutations of NRAS (13.8%), KIT (8.6%) and BRAF (6.4%) were evenly distributed across all tumour site groups. Local relapses were observed in 32.4% and most commonly occurred in the MMHN group (p = 0.016). Male gender (p = 0.047), advanced tumour stage (p = 0.001), nodal disease (p = 0.001) and incomplete resection status (p = 0.001) were independent risk factors for disease progression. Overall survival (OS) was highest in the MMFG group (p = 0.030) and in patients without ulceration (p = 0.004). Multivariate risk factors for OS were M stage at diagnosis (p = 0.002) and incomplete resection of the primary tumour (p = 0.001).
In this large series of MM patients in a European population, anorectal MM was associated with the poorest prognosis.
黏膜黑色素瘤（MM）是一种罕见但多样化的癌症实体。对于白种人黏膜黑色素瘤患者，预后因素尚未得到很好的确立。
我们分析了来自 15 个德国皮肤癌中心的 444 名患者的疾病进程。使用累积发病率函数确定疾病进展。使用 Kaplan-Meier 方法估计生存时间。使用多变量 Cox 回归分析确定预后参数。
原发肿瘤的常见解剖部位为头颈部（MMHN，37.2%）、女性生殖道（MMFG，30.4%）和肛门直肠区域（MMAN，21.8%）。MMAN 患者的垂直肿瘤厚度最高（p=0.001），诊断时淋巴结状态更晚期（p=0.014），转移性疾病的比例更高（p=0.001）。NRAS（13.8%）、KIT（8.6%）和 BRAF（6.4%）的突变在所有肿瘤部位组中分布均匀。局部复发率为 32.4%，最常见于 MMHN 组（p=0.016）。男性（p=0.047）、晚期肿瘤分期（p=0.001）、淋巴结疾病（p=0.001）和不完全切除状态（p=0.001）是疾病进展的独立危险因素。MMFG 组的总生存率（OS）最高（p=0.030），无溃疡的患者 OS 最高（p=0.004）。OS 的多变量危险因素包括诊断时的 M 分期（p=0.002）和原发性肿瘤的不完全切除（p=0.001）。
在这项欧洲人群黏膜黑色素瘤患者的大型研究中，肛门直肠 MM 与最差的预后相关。
