原发性阴道恶性黑色素瘤患者预后影响因素分析:32例病例报道及系统评价  

Prognosis assessment of patients with primary vaginal malignant melanoma:32 cases report and systematic review

作　　者：李慧青 王东 莫佳娅 张嘉琳 雷茜琳 苏引利 段浩然 谢娅[1] LI Huiqing;WANG Dong;MO Jiaya;ZHANG Jialin;LEI Xilin;SU Yinli;DUAN Haoran;XIE Ya(Department of Obstetrics and Gynecology,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院妇科,河南郑州450052

出　　处：《肿瘤基础与临床》2021年第1期41-47,共7页journal of basic and clinical oncology

基　　金：河南省科技厅科技攻关项目(192102310070)。

摘　　要：目的探讨原发性阴道恶性黑色素瘤(PMMV)的预后及其影响因素。方法收集郑州大学第一附属医院2013年1月至2018年6月收治的32例和中英文文献报道69例PMMV患者的临床病理资料,汇总后系统评价PMMV患者临床病理特征、预后及其影响因素。结果共纳入101例PMMV患者。平均发病年龄61岁,79.2%为绝经后女性,局部转移率33.7%,远处转移率6.9%。手术为主要治疗方式,达84.2%,但复发率高(74.4%)。中位无复发生存期(RFS)为11个月。肿瘤直径(χ^(2)=4.487,P=0.034)、淋巴结转移(χ^(2)=8.832,P=0.003)与RFS相关,其中淋巴结转移状态是RFS的独立影响因素(χ^(2)=7.822,P=0.005)。中位总生存期(OS)为16个月,2 a生存率32.0%,5 a生存率17.5%。绝经状态(χ^(2)=11.730,P=0.001)、美国癌症联合会分期(χ^(2)=26.339,P<0.001)、肿瘤厚度(χ^(2)=17.164,P=0.001)、是否溃疡(χ^(2)=10.279,P=0.001)、肿瘤直径(χ^(2)=28.010,P<0.001)、淋巴结转移(χ^(2)=17.381,P<0.001)、阴道外转移(χ^(2)=47.806,P<0.001)、治疗方式(χ^(2)=20.852,P=0.001)、复发情况(χ^(2)=28.375,P<0.001)与患者的OS相关,其中肿瘤直径(χ^(2)=11.978,P=0.001)、肿瘤厚度(χ^(2)=4.296,P=0.038)、阴道外转移(χ^(2)=39.798,P<0.001)是OS的独立影响因素。结论PMMV为好发于绝经后老年女性的罕见妇科肿瘤,复发率高,预后差。肿瘤直径、肿瘤厚度、淋巴结转移、阴道外转移是PMMV预后的独立危险因素,积极手术、术后综合治疗可有效改善患者生存。Objective To identify the prognosis and prognostic factors of primary malignant melanoma of the vagina(PMMV).Methods A systematic review was performed on the basis of data from 32 patients from the First Affiliated Hospital of Zhengzhou University from January 2013 to June 2018 and 69 patients from the previous literature,and the clinical characteristics,prognosis and prognostic factors for PMMV were analyzed.Results This study was enrolled 101 PMMV.The average age at diagnosis was 61 years old.79.2%of PMMV were postmenopausal.The local-and distant-metastasis rate was 33.7%and 6.9%,respectively.Surgery was the main treatment,with a high surgery rate up to 84.2%.While there was a high recurrence rate up to 74.4%.The median recurrence-free survival(RFS)for PMMV patients was 11 months.Univariate analysis showed that tumor size(χ^(2)=4.487,P=0.034)and regional lymph node metastasis status(χ^(2)=8.832,P=0.003)were significantly affected RFS of patients with PMMV.Additionally,the regional lymph node metastasis status was an independent prognostic factor for RFS(χ^(2)=7.822,P=0.005).The median overall survival(OS)of PMMV was 16 months.The 2-year and 5-year survival rates were 32.0%and 17.5%,respectively.The menopausal status(χ^(2)=11.730,P=0.001),stage(χ^(2)=26.339,P<0.001),tumor thickness(χ^(2)=17.164,P=0.001),presence of ulcer(χ^(2)=10.279,P=0.001),tumor size(χ^(2)=28.010,P<0.001),lymph node metastasis status(χ^(2)=17.381,P<0.001),extra-vaginal metastasis(χ^(2)=47.806,P<0.001),treatment(χ^(2)=20.852,P=0.001)and recurrence status(χ^(2)=28.375,P<0.001)were significantly associated with OS in univariate analysis.Multivariate analysis revealed that tumor size(χ^(2)=11.978,P=0.001),tumor thickness(χ^(2)=4.296,P=0.038)and extra-vaginal metastasis(χ^(2)=39.798,P<0.001)were independent prognostic factors for OS.Conclusion PMMV is rare gynecological oncology and more likely to occurs in postmenopausal older women with a high recurrence rate and poor prognosis.In this study,tumor size,tumor thickness,regional lym

关 键 词：原发性阴道恶性黑色素瘤 预后 治疗 

分 类 号：R737.31[医药卫生—肿瘤]