伴复发转移的口腔黏膜黑色素瘤长期生存患者的临床特征及预后分析  

Clinical characteristics and prognosis of long-term survivors of oral mucosal melanoma with recurrence and metastasis

作　　者：梁翔[1] 吴云腾[2] LIANG Xiang;WU Yunteng(Department of Thoracic Surgery,Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Oral&Maxillofacial-Head and Neck Oncology,Shanghai Ninth People’s Hospital,College of Stomatology,Shanghai Jiao Tong University School of Medicine,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology&Shanghai Research Institute of Stomatology,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院胸外科,上海200011 [2]上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海市口腔医学研究所,上海200011

出　　处：《中国癌症杂志》2020年第7期531-537,共7页China Oncology

基　　金：上海交通大学医学院附属第九人民医院种子基金(JYZZ073)。

摘　　要：背景与目的:口腔黏膜黑色素瘤(oral mucosal melanoma,OMM)侵袭性极强,预后极差,在大量长期生存的病例中依然可见肿瘤复发或转移的情况。探讨长期生存的OMM患者的临床病理学特征,分析其与预后的相关性。方法:回顾性分析上海交通大学医学院附属第九人民医院2010年1月—2020年1月收治的总生存期(overall survival,OS)>60个月的OMM患者的临床资料,筛选出发生过复发或转移的病例,多因素方差分析其临床病理学特征与预后的关系。结果:106例OMM患者出现了复发或转移,口腔新发黑色病变是最常见的复发类型(60/106),其中反复复发的病例多达43%(46/106)。单因素分析结果显示,肿瘤的TNM分期(P=0.03)和冷冻治疗新发口腔黑色病变(P=0.005)与OS密切相关。多因素分析结果显示,肿瘤的TNM分期(P=0.03)和活检类型(P<0.000 1)是与无事件生存期(event-free survival,EFS)密切相关的独立预后因素。结论:口腔新发黑色病变是OMM患者最常见的复发类型,需尽早冷冻或扩大切除;冷冻治疗与手术扩大切除相比,操作简单,创伤小,可提高患者的生存质量。Background and purpose: Oral malignant melanoma(OMM) is extremely aggressive and has a poor prognosis.Tumor recurrence or metastasis is still found in many long-term survival cases. The objective of this study was to investigate the clinical characteristics of patients with long-term survival of OMM and analyze its correlation with prognosis. Methods: This was a retrospective cohort study, and data of relapsed OMM patients with an overall survival of >60 months were collected. Predictor variables included sex, age, anatomic site, pigmentation history, tumor type, tumor size, biopsy type, satellite lesions, TNM-staging status and effective treatment. Event-free survival(EFS) and survival after relapse were used as survival analysis. Results: A total of 106 patients were enrolled, 66%(70/106) of whom suffered local recurrence. New pigmentations occurred in 86%(60/70) of relapsed OMM patients, and most of them(82%) were aggressive. TNM-staging status(P=0.03) and treatment mode(P=0.005) were associated with survival after relapse.TNM-staging status(P=0.03) and biopsy type(P<0.0001) were independent and poor prognostic factors for EFS. Conclusion: New oral pigmentations are the most common recurrent type of OMM patients, which need to be frozen or have extended resection as soon as possible;compared with surgical extended resection, cryotherapy is simple with less trauma, and can improve the quality of life.

关 键 词：口腔黏膜 黑色素瘤 复发 冷冻治疗 

分 类 号：R739.5[医药卫生—肿瘤]