头颈部皮肤与粘膜恶性黑色素瘤的临床探讨  

Study on malignant melanoma of skin and mucous membrane of head and neck

作　　者：黄克伟[1] 纪红[1] 宋丹[1] 何侠[1] 

机构地区：[1]江苏省肿瘤医院放疗科,南京210009

出　　处：《临床肿瘤学杂志》2004年第5期475-478,共4页Chinese Clinical Oncology

基　　金：江苏省 135工程医学重点学科肿瘤放射治疗学资助项目 (苏卫科教 2 0 0 319)

摘　　要：目的 :探讨头颈部皮肤恶性黑色素瘤和粘膜恶性黑色素瘤的转移规律及疗效 ,及头颈部粘膜恶性黑色素瘤套用皮肤恶性黑色素瘤临床分期是否合理。方法 :采用回顾性多因素回归分析 ,将 5 5例头颈部恶性黑色素瘤分成皮肤恶性黑色素瘤组 31例 ,黏膜恶性黑色素瘤 2 4例 ,分析转移规律及预后因素。结果 :皮肤恶性黑色素瘤和粘膜恶性黑色素瘤原发灶复发率、淋巴结转移率、血行转移率分别为 4 8 38%、4 5 16 %、2 1 81%和 37 5 0 %、4 1 6 7%、33 33% ;多因素回归分析两组原发灶复发率、淋巴结转移率、血行转移率有显著性差异 (P <0 0 5 ) ,临床分期、原发灶首次手术方式、起源影响复发率和转移率 (P<0 0 5 )。皮肤恶性黑色素瘤组和粘膜恶性黑色素瘤组 1、3、5年生存率分别为 81 15 %、6 6 2 0 %、4 5 0 7%和 81 95 %、4 9 72 %、39 77% ;多因素回归分析两组间生存率无显著性差异 (P >0 0 5 ) ,临床分期、原发灶首次手术方式、血行转移影响头颈部恶性黑色素瘤生存率 (P <0 0 5 )。分组后行多因素回归分析 ,皮肤恶性黑色素瘤组临床分期与生存率有显著性差异 (P<0 0 1) ,黏膜恶性黑色素瘤组临床分期与生存率无显著性差异 (P >0 0 5 )。结论 :①皮肤恶性黑色素瘤原发灶复发率、淋巴结转移率高 ,粘膜恶性黑色?Objective: To investigate the metastatic rule,curative effect and clinical stages of malignant melanoma of skin and mucous membrane of head and neck.Methods:To study the metastatic rules and prognosis of 31 patients with malignant melanoma of skin and 24 patients with that of mucous membrane of head and neck.By using multiple regresion analysis.Results:The difference of the recurrence rates and metastasis rates of lymph node and blood of malignant melanoma of skin(48.38%,45.16%,21.81%)and mucous membrane(37.50%,41.67%,33.33%)was significant(P<0.05).The clinical stage,operative mode and source effect the recurrence rates and metastasis rates(P<0.05).The difference of the survival rates of the first,3 rd and 5 th year of malignant melanoma of skin(81.57%,66.20%,45.07%)and mucous membrane(81.95%,49.72%,39.77%)were not significant(P>0.05).The clinical stages,operative modes and metastasis of blood effect the survival rates of malignant meleanoma of head and neck (P<0.05).The clinical stages significantly correlated with the survival rate of malignant melanoma of skin(P<0.05)but not of mucous membrane(P>05).Conclusion: ①The recurrence rate and metastasis rate of lymph node of malignant melanoma of skin were high,and metastasis rate of blood of malignant melanoma of mucous memberane was high.The clinical stage,operative mode and source effect recurrence and metastasis.②The clinical stage,operative mode and metastasis of blood significantly correlated with the survival rate.③The clinical stages of malignant melanoma of mucous membrane of head and neck shoud be disscussed more.

关 键 词：粘膜恶性黑色素瘤 原发灶 临床分期 皮肤 头颈部 血行转移 生存率 多因素回归分析 复发率 手术方式 

分 类 号：R739[医药卫生—肿瘤] R735[医药卫生—临床医学]