Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Affiliated with the Faculty of Medicine, Tel Aviv University, Israel.
Eur J Surg Oncol. 2023 Jul;49(7):1275-1282. doi: 10.1016/j.ejso.2023.01.021. Epub 2023 Jan 25.
We aimed to assess characteristics, treatment, and outcomes of rectal melanoma (RM).
This retrospective cohort study looked at patients with RM from National Cancer Database (2004-2019) analyzed characteristics and outcomes of the entire cohort and across three time periods (2004-2009; 2010-2014; 2015-2019). Main outcome measures were change in treatment and survival trends across time periods and overall survival (OS).
641 patients (58.5% female; mean age: 68.2 ± 13.6 years) were included. OS rate was 26%; median survival duration was 17.9 (IQR: 15.93-20.67) months. There was a significant decrease in the use of chemotherapy (17.3%-6.6%; p = 0.001) and surgery (62.9%-41.8%; p = 0.00004) but increased use of immunotherapy (11.9%-52%; p < 0.001) across time periods. OS was longer in the last time period than in the first two (21.8 vs 16.8 vs 16.5 months; p = 0.09). Surgical excision was an independent predictor of improved OS (HR = 0.266, 95%CI: 0.089-0.789, p = 0.017) whereas older age (HR = 1.039, 95%CI: 1.007-1.072, p = 0.016), positive resection margins (HR = 5.06, 95%CI: 1.902-13.48, p = 0.001) and metastasis (HR = 34.62, 95%CI: 3.973-301.6, p = 0.001) were predictors of poor survival.
Over time, chemotherapy and surgery have been used less often in the treatment of RM while the use of immunotherapy increased by more than four-fold. Older age, surgical treatment, positive resection margins, and metastasis were predictive of survival of RM.
本研究旨在评估直肠黑色素瘤（RM）的特征、治疗方法和预后。
本回顾性队列研究纳入了国家癌症数据库（2004-2019 年）中 RM 患者，分析了整个队列和三个时间段（2004-2009 年、2010-2014 年、2015-2019 年）的特征和结局。主要观察指标为各时间段治疗方法和生存趋势的变化以及总生存（OS）。
共纳入 641 例患者（58.5%为女性；平均年龄：68.2±13.6 岁）。OS 率为 26%；中位生存时间为 17.9（IQR：15.93-20.67）个月。随着时间的推移，化疗（17.3%-6.6%；p=0.001）和手术（62.9%-41.8%；p=0.00004）的使用率显著下降，但免疫治疗的使用率（11.9%-52%；p<0.001）显著增加。与前两个时间段相比，最后一个时间段的 OS 更长（21.8 个月比 16.8 个月比 16.5 个月；p=0.09）。手术切除是 OS 改善的独立预测因素（HR=0.266，95%CI：0.089-0.789，p=0.017），而年龄较大（HR=1.039，95%CI：1.007-1.072，p=0.016）、切缘阳性（HR=5.06，95%CI：1.902-13.48，p=0.001）和转移（HR=34.62，95%CI：3.973-301.6，p=0.001）是预后不良的预测因素。
随着时间的推移，RM 的治疗中化疗和手术的应用越来越少，而免疫治疗的应用增加了四倍多。年龄较大、手术治疗、切缘阳性和转移是 RM 生存的预测因素。
