Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
Center of Ear, Nose, and Throat Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuana.
Laryngoscope. 2021 Nov;131(11):2429-2435. doi: 10.1002/lary.29574. Epub 2021 Apr 17.
Sinonasal mucosal melanoma (SNMM) is an aggressive cancer usually managed with surgical resection. This study evaluates the impact of treatment modality and positive surgical margin (PSM) on survival following resection of SNMM.
Retrospective study of a national cancer registry.
The National Cancer Database was queried for cases of SNMM from 2010 to 2015. Data regarding patient demographics, tumor staging, and treatment modality were obtained. Survival rates were compared by margin status: PSM, negative (NSM), and no operation (0SM) using Kaplan-Meier analysis and log rank test.
A total of 446 patients met inclusion criteria. Most cases were elderly (>66 years-old) (67.3%), female (54.3%), and white (89.5%). Cases of SNMM most commonly involved the nasal cavity (81.6%), were Stage 3 (60.0%), and underwent surgical resection at an academic center (65.0%). NSM and PSM were present in 59.0% and 26.9% of cases, respectively, while 14.1% of cases did not undergo surgical resection (0SM). Factors predictive of PSM included resection at a community hospital (OR 2.47) and Stage 4 disease (OR 2.07). The 2-year survival rates were 72.1% (95% CI 69.4-75.4%), 36.3% (95% CI 22.0-48.9), and 16.0% (95% CI 8.2-25.4%) for NSM, PSM and 0SM, respectively. Survival was statistically significant between NSM and PSM (Log rank <0.001) but not between 0SM and PSM (Log rank = 0.062).
Our study emphasizes the need for NSM for SNMM as PSM did not demonstrate any significant improvement in survival when compared to 0SM. Our findings suggest that cases of SNMM are best managed at academic centers.
4 Laryngoscope, 131:2429-2435, 2021.
鼻腔鼻窦黑色素瘤（SNMM）是一种侵袭性癌症，通常采用手术切除治疗。本研究评估了切除 SNMM 后，治疗方式和阳性手术切缘（PSM）对生存的影响。
全国癌症登记处的回顾性研究。
2010 年至 2015 年，国家癌症数据库查询了 SNMM 病例。获得了患者人口统计学、肿瘤分期和治疗方式的数据。通过 Kaplan-Meier 分析和对数秩检验，根据切缘状态（PSM、阴性（NSM）和无手术（0SM））比较生存率。
共纳入 446 例患者。大多数病例为老年人（>66 岁）（67.3%）、女性（54.3%）和白人（89.5%）。SNMM 最常见的病例涉及鼻腔（81.6%），分期为 3 期（60.0%），并在学术中心进行手术切除（65.0%）。NSM 和 PSM 的存在率分别为 59.0%和 26.9%，而 14.1%的病例未行手术切除（0SM）。PSM 的预测因素包括在社区医院进行切除（OR 2.47）和 4 期疾病（OR 2.07）。NSM、PSM 和 0SM 的 2 年生存率分别为 72.1%（95%CI 69.4-75.4%）、36.3%（95%CI 22.0-48.9%）和 16.0%（95%CI 8.2-25.4%）。NSM 和 PSM 之间的生存率存在统计学差异（对数秩<0.001），但 0SM 和 PSM 之间的差异无统计学意义（对数秩=0.062）。
本研究强调了对 SNMM 进行 NSM 的必要性，因为与 0SM 相比，PSM 并不能显著改善生存。我们的研究结果表明，SNMM 最好在学术中心进行管理。
4 级喉镜，131：2429-2435，2021。
