St George's University of London, - Chelsea and Wesminster Hospital, London, United Kingdom.
St George's University of London, St George's Hospital, London, United Kingdom.
Medicine (Baltimore). 2022 Aug 5;101(31):e29979. doi: 10.1097/MD.0000000000029979.
Mucosal melanoma (MM) is a rare disease, accounting for approximately 1.4% of all melanomas and only 0.03% of all new cancer diagnoses. Traditionally, it has been associated with a poor prognosis, with an overall 5-year survival rate of <25%. Progress in treatment has been hindered by its rarity and lack of evidence. However, studies on the treatment of subcutaneous melanoma with immunotherapy have demonstrated significant improvement in survival rates and have become a core part of oncological strategies. This paper discusses the revision of the evidence for the use of immunotherapy in the head and neck.
This systematic review was conducted on January 19, 2019. The Medline and Embase databases were searched. In total, 509 articles were collated and screened. Inclusion criteria for the study included treatment-naive cohorts, cohorts with recurrent disease, primary outcomes with overall survival and disease-free survival at 5 years and at the longest follow-up, and studies of adults with MM in whom immunotherapy was reported as a treatment strategy. The exclusion criteria included duplicate papers, anatomical sites other than the head and neck, case reports, and those not published in English.
Fifty-two papers out of the 509 collated papers met the inclusion criteria. The results are shown as a comparison of yearly survival rates following different treatment modalities (immunotherapy vs nonimmunotherapy) at 2, 3, and 5 years. It was found that, with immunotherapy, survival rates at all intervals were higher than those without immunotherapy.
Immunotherapy outcomes in small studies have shown good data for increasing survival rates at yearly intervals in MM of the head and neck. Larger clinical trials are needed to accurately distinguish the efficacy and survival outcomes of immunotherapy when compared with treatment modalities, excluding immunotherapy. However, the ability to perform larger trials is limited by the rarity of MM of the head and neck.
黏膜黑色素瘤（MM）是一种罕见的疾病，约占所有黑色素瘤的 1.4%，仅占所有新发癌症诊断的 0.03%。传统上，它与预后不良相关，总 5 年生存率<25%。由于其罕见性和缺乏证据，治疗进展受到阻碍。然而，免疫疗法治疗皮下黑色素瘤的研究表明，生存率显著提高，已成为肿瘤学策略的核心部分。本文讨论了修订头颈部免疫治疗证据的问题。
本系统评价于 2019 年 1 月 19 日进行。检索了 Medline 和 Embase 数据库。共整理和筛选了 509 篇文章。研究纳入标准包括治疗初治队列、复发性疾病队列、主要终点为 5 年和最长随访时的总生存率和无病生存率，以及报告免疫治疗作为治疗策略的成人 MM 研究。排除标准包括重复论文、头颈部以外的解剖部位、病例报告以及未以英文发表的论文。
从整理的 509 篇论文中，有 52 篇符合纳入标准。结果显示为不同治疗方法（免疫治疗与非免疫治疗）在 2、3 和 5 年时的年生存率比较。结果发现，免疫治疗后，所有时间间隔的生存率均高于无免疫治疗。
小研究中的免疫治疗结果表明，头颈部 MM 的年生存率在免疫治疗方面有较好的数据。需要更大的临床试验来准确区分免疫治疗与排除免疫治疗的治疗方式的疗效和生存结局。然而，由于头颈部 MM 的罕见性，进行更大规模试验的能力受到限制。
