头颈部黏膜黑色素瘤的治疗结果：免疫检查点抑制剂对晚期疾病的疗效。
Treatment outcomes of mucosal melanoma of head and neck: Efficacy of immune checkpoint inhibitors for advanced disease.
作者信息
Ohshima Shusuke, Ueki Yushi, Yokoyama Yusuke, Takahashi Takeshi, Shodo Ryusuke, Yamazaki Keisuke, Okabe Ryuichi, Matsuyama Hiroshi, Togashi Takafumi, Takatsuka Sumiko, Takenouchi Tatsuya, Horii Arata
机构信息
Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Division of Otorhinolaryngology, Nagaoka Red Cross Hospital, Niigata, Japan.
出版信息
Front Surg. 2022 Dec 26;9:1032626. doi: 10.3389/fsurg.2022.1032626. eCollection 2022.
BACKGROUND
Head and neck mucosal melanoma (HNMM) is a rare and aggressive subtype of melanoma. HNMM often develops as a recurrent or metastatic disease, and its prognosis is worse than that of cutaneous melanoma. Recent large-scale clinical studies have reported favorable outcomes with immune checkpoint inhibitors (ICIs) for melanoma. However, these clinical trials included only a small number of HNMM cases. This study aimed to estimate treatment outcomes and prognostic predictors of ICIs for advanced HNMM.
METHODS
Cases of advanced HNMM, defined as unresectable or metastatic HNMM at the initial diagnosis (five patients) or development of recurrent/metastatic HNMM after initial treatment (27 patients), were included in this study. Survival analysis and a search for prognostic factors were performed for these 32 patients. Furthermore, the detailed clinical course of patients who received ICI treatment was investigated.
RESULTS
The median overall survival (OS) of 32 patients with advanced HNMM was 25.3 months. The estimated 1-, 3-, and 5-year OS rates were 68.4%, 42.8%, and 34.3%, respectively. Fourteen patients (43.7%) received ICIs, whereas 18 (56.3%) did not. Univariate analysis showed that ICI treatment was the only factor associated with a better 1-year OS. Patients who received ICI treatment had significantly longer OS (median OS: not reached, 1-year OS: 85.7%) than those who did not (median OS: 11.3 months, 1-year OS: 54.5%). The overall response and disease control rates of patients who received ICI treatment were 50% and 64.3%, respectively. Patients who achieved complete response (CR) or partial response (PR) to ICI treatment survived significantly longer (1-year OS: 100%) than those who did not (1-year OS: 71.4%). Among the five patients who discontinued ICI treatment due to severe immune-related adverse events (irAEs), four did not receive salvage treatments but showed durable treatment effects and survived for 9.8-54.2 months at the end of the follow-up period.
CONCLUSIONS
ICI treatment achieved a favorable OS for advanced HNMM. CR/PR to ICI treatment and discontinuation owing to severe irAEs were favorable predictors of OS.
背景
头颈部黏膜黑色素瘤（HNMM）是一种罕见且侵袭性强的黑色素瘤亚型。HNMM常以复发或转移性疾病形式出现，其预后比皮肤黑色素瘤更差。近期大规模临床研究报道了免疫检查点抑制剂（ICI）治疗黑色素瘤的良好疗效。然而，这些临床试验仅纳入了少量HNMM病例。本研究旨在评估ICI治疗晚期HNMM的疗效及预后预测因素。
方法
本研究纳入了晚期HNMM病例，定义为初诊时不可切除或转移性HNMM（5例）或初始治疗后出现复发/转移性HNMM（27例）。对这32例患者进行生存分析并寻找预后因素。此外，还对接受ICI治疗患者的详细临床病程进行了调查。
结果
32例晚期HNMM患者的中位总生存期（OS）为25.3个月。估计的1年、3年和5年OS率分别为68.4%、42.8%和34.3%。14例患者（43.7%）接受了ICI治疗，18例（56.3%）未接受。单因素分析显示，ICI治疗是与1年较好OS相关的唯一因素。接受ICI治疗的患者OS显著长于未接受治疗的患者（中位OS：未达到，1年OS：85.7%）（中位OS：11.3个月，1年OS：54.5%）。接受ICI治疗患者的总体缓解率和疾病控制率分别为50%和64.3%。对ICI治疗达到完全缓解（CR）或部分缓解（PR）的患者生存期显著长于未达到的患者（1年OS：100%）（1年OS：71.4%）。在因严重免疫相关不良事件（irAE）而停用ICI治疗的5例患者中，4例未接受挽救治疗，但显示出持久的治疗效果，随访期末生存9.8 - 54.2个月。
结论
ICI治疗对晚期HNMM取得了良好的OS。对ICI治疗的CR/PR以及因严重irAE而停药是OS的良好预测因素。
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