Mitra Devarati, Farr Morgan, Nagarajan Priyadharsini, Ho Joel, Bishop Andrew J, Jhingran Anuja, Farooqi Ahsan S, Frumovitz Michael, Amaria Rodabe N, McQuade Jennifer L, Jazaeri Amir A, Guadagnolo B Ashleigh
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Gynecol Oncol. 2022 Dec;167(3):483-489. doi: 10.1016/j.ygyno.2022.09.026. Epub 2022 Oct 11.
Gynecologic tract melanoma (GTM) is a rare malignancy with historically poor outcomes. The current study examines patterns of care and oncologic outcomes in a large single-institution cohort from the contemporary therapeutic era.
Patterns of care and predictors of outcomes were evaluated for all GTM patients without metastatic disease at diagnosis who were treated at our institution between 2009 and 2020 with >6 months of follow-up.
Of the 124 patients included, anatomic subsites were vulvar (n = 82, 66%), vaginal (n = 34, 27%), or cervical (n = 8, 6%). Primary tumor was resected for 85% (n = 106) with surgical nodal evaluation for 60% (n = 75). Systemic therapy, most commonly immune checkpoint inhibitors (ICI, 58% systemic therapy), was used to treat all except one unresectable patient (17/18) and 33% (35/106) of resectable patients. Seven patients received neoadjuvant ICI. Fourteen patients received adjuvant radiation therapy to the pelvis (RT, 13% of those undergoing resection). With a median follow-up of 45 months, 100 patients (81%) recurred. Four-year actuarial outcomes were: 46% local control, 53% nodal control, 36% distant metastasis-free survival, 17% disease-free survival, 49% melanoma-specific survival and 48% overall survival. Mitotic rate > 10/mm, nodal involvement and non-vulvar anatomic subsite were associated with poor outcomes. Patients treated after 2016 did not have significantly better outcomes than those treated earlier.
Patients with GTM continue to have poor outcomes in the contemporary therapeutic era with particularly notable poor local disease control relative to other mucosal melanoma subtypes. More effective oncologic therapy is needed.
妇科黑色素瘤（GTM）是一种罕见的恶性肿瘤，历来预后较差。本研究调查了当代治疗时代一个大型单机构队列中的治疗模式和肿瘤学结局。
对2009年至2020年期间在本机构接受治疗、诊断时无转移性疾病且随访时间超过6个月的所有GTM患者的治疗模式和结局预测因素进行评估。
纳入的124例患者中，解剖部位为外阴（n = 82，66%）、阴道（n = 34，27%）或宫颈（n = 8，6%）。85%（n = 106）的患者切除了原发肿瘤，60%（n = 75）的患者进行了手术淋巴结评估。除1例不可切除患者（17/18）外，所有患者均接受了全身治疗，33%（35/106）的可切除患者接受了全身治疗，最常用的是免疫检查点抑制剂（ICI，58%的全身治疗）。7例患者接受了新辅助ICI治疗。14例患者接受了盆腔辅助放疗（RT，占接受切除术患者的13%）。中位随访45个月，100例患者（81%）复发。4年精算结局为：局部控制率46%，淋巴结控制率53%，无远处转移生存率36%，无病生存率17%，黑色素瘤特异性生存率49%，总生存率48%。有丝分裂率>10/mm、淋巴结受累和非外阴解剖部位与不良结局相关。2016年后接受治疗的患者结局并不比早期接受治疗的患者明显更好。
在当代治疗时代，GTM患者的结局仍然较差，相对于其他黏膜黑色素瘤亚型，局部疾病控制尤其显著较差。需要更有效的肿瘤治疗方法。
