Amit Moran, Tam Samantha, Abdelmeguid Ahmed S, Kupferman Michael E, Su Shirley Y, Raza Shaan M, DeMonte Franco, Hanna Ehab Y
Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States.
Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Mansoura University, Egypt.
J Neurol Surg B Skull Base. 2017 Dec;78(6):512-518. doi: 10.1055/s-0037-1604350. Epub 2017 Jul 31.
Sinonasal mucosal melanoma (SNMM) is a locally aggressive tumor. This study aimed to define the role of adjuvant treatment and its association with survival outcomes of SNMM. This retrospective study investigated 152 patients with SNMM treated between 1991 and 2016 in MD Anderson Cancer Center. Patients were divided into the following treatment groups: surgery alone, surgery with postoperative radiotherapy (PORT), surgery with postoperative chemoradiation (POCRT), and induction chemotherapy followed by surgery and PORT. Overall survival (OS), disease-specific survival, and relapse-free survival were compared. Survival between the groups was compared using univariate and multivariate analyses. The median follow-up was 28 months (range: 2-220 months). Five-year OS rates were 39, 42, 47, and 27% for the surgery only, PORT, POCRT, and neoadjuvant chemotherapy groups, respectively (log rank = 0.73). Distant metastasis was the most common form of treatment failure and occurred in 59 (39%) patients. Five-year distant metastasis rates were 51, 45, and 58% for patients treated with surgery alone, PORT, and POCRT, respectively (log rank = 0.21) but unable to be estimated in the neoadjuvant chemotherapy group due to low OS rates. Multivariate analysis demonstrated tumor site (hazard ratio [HR] = 2.32, 95% confidence interval [CI] = 1.24-4.15) and smoking status (HR = 1.77, 95% CI = 1.02-3.1) to be significant prognostic factors for survival. Tumor site and smoking status were significant prognosticators in SNMM. A high rate of distant metastatic disease suggests that further investigation into novel, systemic therapies is required to improve outcomes in this disease entity.
鼻窦黏膜黑色素瘤（SNMM）是一种具有局部侵袭性的肿瘤。本研究旨在明确辅助治疗的作用及其与SNMM生存结局的关联。
这项回顾性研究调查了1991年至2016年期间在MD安德森癌症中心接受治疗的152例SNMM患者。患者被分为以下治疗组：单纯手术、术后放疗（PORT）、术后放化疗（POCRT）以及诱导化疗后手术加PORT。比较了总生存期（OS）、疾病特异性生存期和无复发生存期。采用单因素和多因素分析比较各组之间的生存率。
中位随访时间为28个月（范围：2 - 220个月）。单纯手术、PORT、POCRT和新辅助化疗组的5年OS率分别为39%、42%、47%和27%（对数秩检验=0.73）。远处转移是最常见的治疗失败形式，发生在59例（39%）患者中。单纯手术、PORT和POCRT治疗的患者5年远处转移率分别为51%、45%和58%（对数秩检验=0.21），但由于OS率较低，新辅助化疗组无法估计远处转移率。多因素分析表明肿瘤部位（风险比[HR]=2.32，95%置信区间[CI]=1.24 - 4.15）和吸烟状态（HR=1.77，95%CI=1.02 - 3.1）是生存的重要预后因素。
肿瘤部位和吸烟状态是SNMM的重要预后指标。远处转移性疾病的高发生率表明需要进一步研究新的全身治疗方法以改善该疾病实体的治疗结局。
