Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura City, Egypt.
Cancer. 2018 Feb 1;124(3):514-520. doi: 10.1002/cncr.31083. Epub 2017 Oct 17.
Mucosal melanomas in the head and neck region are most often located in the nasal cavity and paranasal sinuses. To the authors' knowledge, the prognostic effects of lymph node metastasis in patients with sinonasal mucosal melanoma (SNMM) have not been established. Therefore, the objective of the current study was to determine the effects of lymph node metastasis on survival.
The current study included 198 patients with SNMM who had been treated between 1985 and 2016 at The University of Texas MD Anderson Cancer Center in Houston. Patients' clinical and pathologic lymph node statuses were evaluated and characterized. A multivariate analysis was used to assess the associations between regional spread and survival outcomes.
Therapeutic neck dissection was performed in 23 patients with SNMM (11.6%). Regional disease recurrence occurred in 7 of the patients who had lymph node metastasis at the time of presentation (30.4%) and in 30 of those who had N0 disease at the time of presentation (17.1%) (P = .15). Metastasis to the contralateral lymph nodes was present in 7 patients (3.5%). The 5-year disease-specific survival rate was 66% in patients with lymph node spread compared with 45% in patients with N0 status (P = .04, log-rank test). A multivariate analysis demonstrated that distant metastasis was the only variable found to be independently associated with both overall survival (hazard ratio, 2.96; 95% confidence interval, 1.54-6.95 [P = .01]) and disease-specific survival (hazard ratio, 3.32; 95% confidence interval, 1.79-7.14 [P = 0.01]).
The results of the current study demonstrated that lymph node status in patients with SNMM was not a significant predictor of outcome. This finding, together with the low incidence of lymph node metastases in patients with SNMM, suggests that elective treatment of the neck should be highly selective in this patient population. Cancer 2018;124:514-20. © 2017 American Cancer Society.
头颈部黏膜黑色素瘤通常位于鼻腔和鼻旁窦。据作者所知，鼻旁窦黏膜黑色素瘤（SNMM）患者的淋巴结转移的预后影响尚未确定。因此，本研究的目的是确定淋巴结转移对生存的影响。
本研究纳入了 198 例于 1985 年至 2016 年在休斯顿德克萨斯大学 MD 安德森癌症中心接受治疗的 SNMM 患者。评估并描述了患者的临床和病理淋巴结状态。采用多变量分析评估局部扩散与生存结果之间的关联。
23 例 SNMM 患者（11.6%）进行了治疗性颈部淋巴结清扫术。在出现时伴有淋巴结转移的患者中有 7 例（30.4%）发生区域疾病复发，在出现时为 N0 疾病的患者中有 30 例（17.1%）发生区域疾病复发（P=0.15）。在 7 例患者中存在对侧淋巴结转移（3.5%）。有淋巴结转移的患者 5 年疾病特异性生存率为 66%，而 N0 状态的患者为 45%（P=0.04，对数秩检验）。多变量分析表明，远处转移是唯一与总生存（风险比，2.96；95%置信区间，1.54-6.95[P=0.01]）和疾病特异性生存（风险比，3.32；95%置信区间，1.79-7.14[P=0.01]）均相关的独立变量。
本研究的结果表明，SNMM 患者的淋巴结状态不是预后的显著预测因素。这一发现，加上 SNMM 患者淋巴结转移的发生率较低，提示在这一患者人群中，选择性治疗颈部应高度选择。癌症 2018；124：514-20。©2017 美国癌症协会。
