Creighton University School of Medicine, Phoenix Regional Campus, 525 W. Earll Dr., Phoenix, AZ 85013, USA; Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.
Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.
Oral Oncol. 2017 Oct;73:36-42. doi: 10.1016/j.oraloncology.2017.08.002. Epub 2017 Aug 10.
To evaluate hospital-based data of head and neck mucosal melanoma patients in order to identify predictors of survival.
The National Cancer Data Base was used to identify 1368 patients with head and neck mucosal melanoma diagnosed between the years of 2004 and 2012. The Kaplan-Meier method was utilized to estimate overall survival, and multivariate Cox regression analyses were performed to assess the impact of covariates on survival after adjusting for confounding variables.
Median follow-up was 55.2months. Median survival of all patients was 29.3months, and the 5-year survival was 27.4%. After adjusting for other prognostic factors in multivariate analysis, paranasal sinus location [hazard ratio (HR)=1.54, 95% Confidence Interval (CI)=1.30-1.82, P<0.001)] and the use of radiotherapy alone for definitive local treatment (HR=2.27, 95% CI=1.72-2.98, P<0.001) were associated with worse survival. Similar results were seen in the subgroup of patients with complete clinical staging information. In terms of patterns of care, the use of combined surgery and radiotherapy as the primary local treatment modality has significant increased from 2004 and 2012 (P=0.03).
Outcomes in mucosal melanoma of the head and neck remain suboptimal, despite increased use of multimodality local therapy, likely due to the high risk of distant metastases. Mucosal melanomas arising from the paranasal sinuses have particularly poor prognosis. Novel therapeutic paradigms for head and neck mucosal melanoma, incorporating systemic therapies to decrease the risk of distant relapse, should be pursued in clinical trials.
评估头颈部黏膜黑色素瘤患者的医院数据，以确定生存的预测因素。
利用国家癌症数据库，鉴定了 2004 年至 2012 年间诊断的 1368 例头颈部黏膜黑色素瘤患者。采用 Kaplan-Meier 法估计总生存率，采用多变量 Cox 回归分析评估调整混杂因素后，协变量对生存的影响。
中位随访时间为 55.2 个月。所有患者的中位生存期为 29.3 个月，5 年生存率为 27.4%。多变量分析调整其他预后因素后，鼻窦部位[风险比（HR）=1.54，95%置信区间（CI）=1.30-1.82，P<0.001)]和单独放疗作为确定性局部治疗[HR=2.27，95%CI=1.72-2.98，P<0.001)]与生存较差相关。在有完整临床分期信息的亚组患者中也观察到了相似的结果。在治疗模式方面，将手术联合放疗作为主要局部治疗方式的应用显著增加，从 2004 年到 2012 年（P=0.03）。
尽管采用了多种局部治疗方法，但头颈部黏膜黑色素瘤的预后仍不理想，这可能是由于远处转移的风险较高。来自鼻窦的黏膜黑色素瘤预后尤其差。应在临床试验中探索针对头颈部黏膜黑色素瘤的新治疗模式，纳入系统治疗以降低远处复发的风险。
