Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA.
Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA.
Int Forum Allergy Rhinol. 2023 Dec;13(12):2156-2164. doi: 10.1002/alr.23204. Epub 2023 Jun 15.
To evaluate recurrence patterns and survival after recurrence among patients with sinonasal mucosal melanoma (SNMM).
This was a multi-institutional retrospective review from seven U.S. institutions of patients with SNMM from 1991 to 2022. Recurrence was categorized as local, regional, distant, or multifocal. Kaplan-Meier tests were used to evaluate disease-free survival (DFS), overall survival (OS), and post-recurrence survival (PRS) reported with standard errors (SE) and log-rank testing used for comparison. Cox-regression was further used, with hazard ratios (HR) and 95% confidence intervals (CI) reported.
Among 196 patients with SNMM, there were 146 patients with recurrence (74.5%). Among all patients, 60-month DFS (SE) was 15.5% (2.9%), 60-month OS (SE) was 44.7% (3.7%), mean age ± standard deviation at diagnosis was 69.7 ± 12.5 years, and 54.6% were female. In 26 patients who underwent primary treatment of the neck, 60-month DFS did not differ from no treatment (p > 0.05). Isolated distant recurrence was most common (42.8%), followed by local (28.3%), multifocal (20.7%), and regional recurrence (8.3%). Among patients with regional recurrence in the neck, there was no 60-month PRS benefit for patients undergoing salvage neck dissection or radiation (p > 0.05). Among patients with distant recurrence, only immunotherapy was associated with improved 12-month PRS (HR = 0.32, 95% CI = 0.11-0.92, p = 0.034), and no treatment group was associated with improved 24- or 60-month PRS (p > 0.05).
SNMM is associated with a high recurrence rate and poor survival. Primary treatment of the neck was not associated with reduced recurrence, and immunotherapy for treatment of distant recurrence was associated with increased 12-month PRS.
评估鼻-鼻窦黏膜黑色素瘤（SNMM）患者的复发模式和复发后的生存情况。
这是一项来自美国 7 家机构的多机构回顾性研究，纳入了 1991 年至 2022 年期间的 SNMM 患者。复发分为局部、区域、远处或多灶性。采用 Kaplan-Meier 检验评估无疾病生存（DFS）、总生存（OS）和复发后生存（PRS），并报告标准误差（SE）和对数秩检验用于比较。进一步使用 Cox 回归，报告风险比（HR）和 95%置信区间（CI）。
在 196 例 SNMM 患者中，有 146 例（74.5%）患者发生了复发。在所有患者中，60 个月的 DFS（SE）为 15.5%（2.9%），60 个月的 OS（SE）为 44.7%（3.7%），诊断时的平均年龄±标准差为 69.7±12.5 岁，54.6%为女性。在 26 例接受颈部原发治疗的患者中，DFS 无治疗组和治疗组之间无差异（p>0.05）。孤立性远处复发最为常见（42.8%），其次是局部复发（28.3%）、多灶性复发（20.7%）和区域复发（8.3%）。对于颈部区域复发的患者，挽救性颈部清扫术或放疗对区域复发患者的 60 个月 PRS 没有获益（p>0.05）。对于远处复发的患者，只有免疫治疗与改善 12 个月 PRS 相关（HR=0.32，95%CI=0.11-0.92，p=0.034），无治疗组与改善 24 个月或 60 个月 PRS 相关（p>0.05）。
SNMM 复发率高，生存预后差。颈部的原发治疗与降低复发无关，免疫治疗远处复发与增加 12 个月 PRS 相关。
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