Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
Laryngoscope. 2023 Feb;133(2):317-326. doi: 10.1002/lary.30152. Epub 2022 May 13.
Mucosal melanoma (MM) is a rare malignancy that can present in the head and neck (H&N). The Oral cavity is the second most common primary site in the H&N after sinonasal mucosa. This study investigates the impact of demographic and clinical factors on survival in oral cavity MM. Further, it investigates the outcomes and utility of elective neck dissections (END) in the management of oral MM.
The National Cancer Database was used to evaluate 432 patients with oral cavity MM from 2004 to 2016. Kaplan-Meir and Cox regression analyses were used to determine variables associated with survival.
The mean age was 64.0 ± 16.0 years. Most patients were white (85.1%) and male (60.0%). Gingiva (37.6%) and hard palate (36.1%) were the most common primary subsites in the oral cavity. Five-year overall survival was 31.0%. Age (Hazards Ratio [95% Confidence Interval], 1.03 [1.01-1.06]), N-stage (1.94 [1.10-3.42]), M-stage (10.13 [3.33-30.86]), male sex (1.79 [1.06-3.03]), and African-American race (2.63 [1.14-6.11]) were significantly associated with worse survival. 199 patients (46.9%) underwent neck dissection including 118 with lymph node yield (LNY) ≥ 18. The rate of occult nodal positivity was 45.4% for LNY ≥ 18 and 28.3% for LNY ≥ 1. ENDs were not associated with improved outcomes. However, occult lymph node involvement was associated with worse overall survival (p = 0.004).
Oral cavity MM has a poor prognosis. Lymph node involvement, distant metastasis, age, race, and male sex are associated with worse outcomes. Performing an END did not improve survival. However, END may have a prognostic role and help select patients for treatment intensification.
4 Laryngoscope, 133:317-326, 2023.
黏膜黑色素瘤（MM）是一种罕见的恶性肿瘤，可发生在头颈部（H&N）。口腔是继鼻腔-鼻窦黏膜之后 H&N 的第二大原发性部位。本研究探讨了人口统计学和临床因素对口腔 MM 生存的影响。此外，还研究了选择性颈部清扫术（END）在口腔 MM 治疗中的结果和作用。
使用国家癌症数据库评估了 2004 年至 2016 年间 432 例口腔 MM 患者。使用 Kaplan-Meier 和 Cox 回归分析确定与生存相关的变量。
平均年龄为 64.0±16.0 岁。大多数患者为白人（85.1%）和男性（60.0%）。牙龈（37.6%）和硬腭（36.1%）是口腔中最常见的原发性部位。5 年总生存率为 31.0%。年龄（危险比[95%置信区间]，1.03[1.01-1.06]）、N 期（1.94[1.10-3.42]）、M 期（10.13[3.33-30.86]）、男性（1.79[1.06-3.03]）和非裔美国人（2.63[1.14-6.11]）与较差的生存显著相关。199 例（46.9%）患者行颈部清扫术，其中 118 例有淋巴结清扫（LNY）≥18。LNY≥18 的隐匿性淋巴结阳性率为 45.4%，LNY≥1 的隐匿性淋巴结阳性率为 28.3%。END 并不能改善预后。然而，隐匿性淋巴结受累与总生存期较差相关（p=0.004）。
口腔 MM 预后不良。淋巴结受累、远处转移、年龄、种族和性别与不良预后相关。进行 END 并不能提高生存率。然而，END 可能具有预后作用，并有助于选择需要强化治疗的患者。
4 级喉镜，133：317-326，2023。
