Johns Hopkins University School of Medicine, 733 N. Broadway, Suite G-45, Baltimore, MD, 21205, USA.
Queen's University School of Medicine, Kingston, Canada.
World J Surg. 2019 Jul;43(7):1809-1819. doi: 10.1007/s00268-019-04960-w.
Immunotherapy advances for the treatment of cutaneous melanoma question its efficacy in treating anorectal mucosal melanoma (ARMM). We aimed to identify the prevalence, current management, and overall survival (OS) for ARMM.
Review of patients with ARMM from 2004 to 2015 National Cancer Database. Factors associated with immunotherapy were identified using multivariable logistic regression. The primary outcome was 2- and 5-year OS. Subgroup analysis by treatment type was performed.
A total of 1331 patients were identified with a significant increase in prevalence (2004: 6.99%, 2015: 10.53%). ARMM patients were older, white, on Medicare, and from the South. The most common treatment was surgery (48.77%), followed by surgery + radiation (11.75%), surgery + immunotherapy (8.68%), and surgery + chemotherapy (8.68%). 16.93% of patients received immunotherapy, with utilization increasing (7.24%: 2004, 21.27%: 2015, p < 0.001). Patients who received immunotherapy had a significantly better 2-year OS (42.47% vs. 49.21%, p < 0.001), and other therapies did not reveal a significant difference. Adjusted analysis showed no difference in 2- and 5-year OS based on therapy type.
The prevalence of ARMM has increased. The use of immunotherapy has increased substantially. Some survival benefit with the administration of immunotherapy may exist that has yet to be revealed. A more aggressive treatment paradigm is warranted.
免疫疗法在治疗皮肤黑色素瘤方面的进步对其治疗肛门直肠黏膜黑色素瘤（ARMM）的疗效提出了质疑。我们旨在确定 ARMM 的患病率、当前治疗方法和总生存率（OS）。
回顾 2004 年至 2015 年国家癌症数据库中 ARMM 患者的资料。使用多变量逻辑回归确定与免疫疗法相关的因素。主要结局为 2 年和 5 年 OS。对治疗类型进行亚组分析。
共确定了 1331 例 ARMM 患者，其患病率显著增加（2004 年：6.99%，2015 年：10.53%）。ARMM 患者年龄较大，为白人，享受医疗保险，来自南部。最常见的治疗方法是手术（48.77%），其次是手术+放疗（11.75%）、手术+免疫治疗（8.68%）和手术+化疗（8.68%）。16.93%的患者接受了免疫治疗，使用率逐渐增加（7.24%：2004 年，21.27%：2015 年，p<0.001）。接受免疫治疗的患者 2 年 OS 明显更好（42.47%比 49.21%，p<0.001），而其他治疗方法则无显著差异。调整分析显示，基于治疗类型，2 年和 5 年 OS 无差异。
ARMM 的患病率有所增加。免疫治疗的使用大幅增加。免疫治疗可能存在尚未显现的生存获益。需要更积极的治疗方案。
