Yin G F, Guo W, Chen X H, Liu Z Y, Huang Z G
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Sep 7;53(9):668-674. doi: 10.3760/cma.j.issn.1673-0860.2018.09.006.
To study the clinical characteristics of mucosal melanoma in the head and neck, including the risk factors affecting distant metastasis, recurrence and survival rate, and to provide the basis for the individualized treatment of mucosal melanoma in the head and neck. The clinical data of 117 cases of mucosal melanoma in the head and neck treated from January 2004 to June 2016 in Beijing Tongren Hospital were analyzed retrospectively, and the risk factors affecting the prognosis, distant metastasis and local recurrence were analyzed.Kaplan-Meier analysis was used for survival analysis, and Log-Rank test was used for comparison between groups. The follow-up time was 5-139 months, with a median of 32 months, and the median survival time was 34 months.The 3 and 5 year cumulative survival rates were 47.0% and 25.0%, respectively.Local recurrence occurred in 27 patients (23.1%), and distant metastasis in 37 cases (31.6%). After the operation, 50 patients received radiotherapy.Multiple factor Cox regression analysis showed that distant metastasis, AJCC staging, and two operations were risk factors affecting survival (<0.05), and immunologic/targeted therapy was a protective factor affecting survival prognosis(=0.008). Postoperative radiotherapy and distant metastasis were important factors affecting recurrence (<0.05). AJCC staging, pigmentation, and postoperative recurrence were risk factors for distant metastasis (<0.05). The 3 and 5 year survival rates of primary mucosal melanoma in head and neck are low, and the incidence of local recurrence and distant metastasis are high. Surgery is the first choice and the integrity of the initial operation has an important impact on the prognosis of the patients. Postoperative adjuvant radiotherapy is recommended to improve the local control rate, and immunotherapy and targeted therapy should be applied in time to improve survival.
研究头颈部黏膜黑色素瘤的临床特征，包括影响远处转移、复发及生存率的危险因素，为头颈部黏膜黑色素瘤的个体化治疗提供依据。回顾性分析2004年1月至2016年6月在北京同仁医院治疗的117例头颈部黏膜黑色素瘤患者的临床资料，分析影响预后、远处转移及局部复发的危险因素。采用Kaplan-Meier法进行生存分析，组间比较采用Log-Rank检验。随访时间为5 - 139个月，中位时间为32个月，中位生存时间为34个月。3年和5年累积生存率分别为47.0%和25.0%。27例（23.1%）发生局部复发，37例（31.6%）发生远处转移。术后50例患者接受了放疗。多因素Cox回归分析显示，远处转移、AJCC分期及二次手术是影响生存的危险因素（<0.05），免疫/靶向治疗是影响生存预后的保护因素（=0.008）。术后放疗和远处转移是影响复发的重要因素（<0.05）。AJCC分期、色素沉着及术后复发是远处转移的危险因素（<0.05）。头颈部原发性黏膜黑色素瘤的3年和5年生存率较低，局部复发和远处转移发生率较高。手术是首选，初次手术的完整性对患者预后有重要影响。建议术后辅助放疗以提高局部控制率，应及时应用免疫治疗和靶向治疗以提高生存率。
