非皮肤恶性黑色素瘤65例临床病理分析  

Noncutaneous malignant melanoma: a clinicopathologic analysis of 65 cases

作　　者：朱鸿[1] 董丹丹[1] 李芳华[1] 刘丹丹[1] 王雷[1] 傅静[1] 宋林红[1] 徐钢[1] 

机构地区：[1]四川省医学科学院.四川省人民医院病理科,成都610072

出　　处：《临床与实验病理学杂志》2013年第4期406-410,共5页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨发生于不同解剖位的非皮肤恶性黑色素瘤(noncutaneous malignant melanoma,nonCMM)的临床病理特点及预后差异。方法对65例nonCMM患者进行临床病理观察及生存分析。结果 65例nonCMM中男性35例(53.8%),女性30例(46.2%)。平均年龄63.4岁(标准差s=10.347)。黏膜恶性黑色素瘤(mucosal maligant melaoma,MMM)54例(83.1%),眼球恶性黑色素瘤(ocular malignant melanoma,OMM)11例(16.9%)。其中,发生于鼻腔鼻窦者最常见,共29例(44.6%),依次为口腔8例(12.3%)、泌尿生殖道8例(12.3%)、肛管直肠区7例(10.8%)、食管2例(3.1%);OMM中球内色素膜为最好发部位,7例(10.8%),其次为球结膜,4例(6.2%)。随访3～60个月,中位数27个月,nonCMM总的术后生存时间为36个月(95%CI:34.874～37.126)。Kaplan-Meier法生存分析显示OMM患者术后无复发生存时间明显长于MMM患者(χ2=12.735,P<0.001)。在MMM中,发生于肛管直肠区者术后无复发生存时间要短于来自鼻腔鼻窦、口腔和泌尿生殖道的患者,其χ2和P值分别为18.735、3.867、5.134和<0.001、0.049、0.023,而鼻腔鼻窦、口腔、泌尿生殖道患者之间的生存差异无统计学意义;单因素分析显示患者年龄(χ2=16.889,P<0.001)和肿瘤大小(χ2=4.381,P=0.036)与预后相关,多因素Cox回归生存分析显示患者年龄(χ2=4.447,P=0.035,RR=1.068,95%CI=1.005～1.136)和肿瘤大小(χ2=5.957,P=0.015,RR=1.479,95%CI=1.080～2.026)是影响术后生存的主要危险因素。结论发生于不同解剖位的nonCMM预后有差异,来自OMM的预后明显好于MMM,而MMM中,发生于肛管直肠区者预后最差。患者高龄和肿瘤大小是主要的预后因素。Purpose To study clinicopathologic features and prognostic differences of noncutaneous malignant melanoma （nonCMM） originated from different anatomic sites. Methods Clinicopathologic and survival data were analyzed in 65 cases of nonCMM. Results Of the 65 nonCMM patients, 35 （53.8%） were males and 30 （46. 2% ） females with mean age of 63.4 years （s = 10. 347）. 54 patients had mucosal malignant melanoma （MMM） and 11 patients had ocular malignant melanoma （OMM）. For MMM, sinonasal ar- ea was the most common anatomic site （n = 29, 44. 6% ）, followed by oral cavity （n = 8, 12. 3% ）, genitourinary tract （n = 8, 12. 3% ）, anorectum （n =7, 10. 8% ）, esophagus （n =2, 3.1% ）. For OMM, uveal melanoma （n =7, 10. 8% ） was the most com- mon site, followed by bulbar conjunctiva （ n = 4, 6. 2% ）. With the median follow up for 27 months （ range ： 3 - 60 months）, the me- dian overall survival time was 36 months （95% CI： 34. 874 -37. 126） for all patients. Kaplan-Meier survival analysis suggested that the patients with OMM had distinctly longer survival time than patients with MMM （χ2= 12. 735, P 〈 0. 001 ） and without recurrence after surgery. Patients with anorectal melanoma had shorter survival time than patients with sinonasal, oral cavity and genitourinary tract melannoma without recurrence postoperation, whichχ2values were 18. 735, 3. 867 and 5. 134, respectively, and the P values were 〈 0. 001, 0. 049 and 0. 023 respectively, whereas there were no significantly differences among patients with sinonasal, oral cavity and genitourinary tract melanoma. Univariate analysis suggested the age （ X2 = 16. 889, P 〈 0. 001 ） and tumor size （ χ2= 4. 381, P = 0. 036） were related to the prognosis. Cox regression muhivariate analysis showed the age （χ2= 4. 447, P = 0. 035, RR = 1. 068, 95% CI = 1. 005 - 1. 136） and tumor size （ χ2= 5. 957, P = 0. 015, RR = 1. 479, 95% CI = 1. 080-2. 026 ） were main prognostic risk factors for postoperative sur

关 键 词：黑色素瘤 非皮肤恶性黑色素瘤 黏膜恶性黑色素瘤 眼球恶性黑色素瘤 预后 

分 类 号：R737.9[医药卫生—肿瘤]