Chae Y-S, Lee J-Y, Lee J-W, Park J-Y, Kim S M, Lee J-H
Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Republic of Korea; Dental Research Institute, Seoul National University, Seoul, Republic of Korea.
Dental Research Institute, Seoul National University, Seoul, Republic of Korea.
Br J Oral Maxillofac Surg. 2020 Nov;58(9):1097-1102. doi: 10.1016/j.bjoms.2020.05.028. Epub 2020 Jun 23.
Because of the poor prognosis and of oral mucosal melanoma, and patients' short survival, large, randomised, clinical studies are difficult. We have investigated its demographic characteristics and analysed the effect of treatment, resection margins, and metastases on survival. We recorded age, sex, site of primary tumour, and types of treatment, survival, and metastases in 74 patients treated at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. Survival was analysed based on bony invasion, depth of invasion, and resection margins, and we found that it varied depending on the primary site (p=0.002), and declined with liver (p=0.001) or brain (p=0.033) metastases. The two-year survival according to the primary site was as follows: palate 85% (n=32), anterior maxillary gingiva 53% (n=13), mandible 58% (n=13), and posterior maxillary gingival 74% (n=10) and buccal mucosa 50% (n=4). The two-year survival was 34% (n=8) in patients with liver metastases and 23% (n=7) in patients with brain metastases. In cases of bony invasion (p=0.005), depth of invasion (p=0.042), unclear resection margin (p=0.023), or higher T stages (p=0.009), the survival declined considerably. Neck dissection did not affect survival (p=0.343). Survival of the patients given chemotherapy was significantly lower (p=0.013) and the two-year survival was 54.0%. The patients given radiotherapy showed no significant difference in survival compared with those not given radiotherapy (p=0.107). In conclusion, primary site, bony invasion, resection margins, depth of invasion and systemic metastases were critical to predict prognosis and selection of treatment of oral mucosal melanoma.
由于口腔黏膜黑色素瘤预后较差且患者生存期短，开展大型随机临床研究困难重重。我们对其人口统计学特征进行了调查，并分析了治疗、手术切缘和转移对生存的影响。我们记录了首尔国立大学牙科学院口腔颌面外科治疗的74例患者的年龄、性别、原发肿瘤部位、治疗类型、生存情况和转移情况。基于骨侵犯、侵犯深度和手术切缘对生存情况进行分析，我们发现生存情况因原发部位而异（p = 0.002），并随着肝转移（p = 0.001）或脑转移（p = 0.033）而下降。根据原发部位的两年生存率如下：腭部85%（n = 32），上颌前牙龈53%（n = 13），下颌骨58%（n = 13），上颌后牙龈74%（n = 10）和颊黏膜50%（n = 4）。肝转移患者的两年生存率为34%（n = 8），脑转移患者为23%（n = 7）。在发生骨侵犯（p = 0.005）、侵犯深度（p = 0.042）、手术切缘不明确（p = 0.023）或T分期较高（p = 0.009）的情况下，生存率显著下降。颈部清扫术对生存无影响（p = 0.343）。接受化疗患者的生存率显著较低（p = 0.013），两年生存率为54.0%。接受放疗的患者与未接受放疗的患者相比，生存率无显著差异（p = 0.107）。总之，原发部位、骨侵犯、手术切缘、侵犯深度和全身转移对预测口腔黏膜黑色素瘤的预后和治疗选择至关重要。
