原发性肛管直肠恶性黑色素瘤的临床特征和预后因素研究  

Study on the clinical features and prognostic factors of primary anorectal malignant melanoma

作　　者：冯亚光[1] 韩灵雨 徐烨 王人杰 Feng Yaguang;Han Lingyu;Xu Ye;Wang Renjie(Department of Gastrointestinal Hepatobiliary Surgery,Shangqiu First People′s Hospital,Henan Province476100,China;Department of Colorectal Surgery,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)

机构地区：[1]商丘市第一人民医院胃肠肝胆外科,河南省476100 [2]复旦大学附属肿瘤医院大肠外科复旦大学上海医学院肿瘤学系,200032

出　　处：《中华消化杂志》2021年第4期247-252,共6页Chinese Journal of Digestion

摘　　要：目的分析肛管直肠恶性黑色素瘤(AMM)的临床病理特征对其预后的影响,并建立更精准的预后预测模型。方法回顾性分析2006年1月1日至2018年12月31日在复旦大学附属肿瘤医院确诊并接受手术治疗的89例AMM患者资料。采用Cox比例风险回归模型分析预后影响因素。采用向后逐步回归法挑选变量,建立Nomogram预后预测模型并进行内部验证,计算一致性指数。结果89例AMM患者中65例(73.0%)为女性,78例(87.6%)年龄<70岁;最常见的肿瘤部位为直肠(48.3%,43例),其次为肛管(31.5%,28例)和直肠肛管(20.2%,18例)。38例(42.7%)患者直接接受了腹会阴切除术,37例(41.6%)接受了以干扰素为主的免疫治疗,11例(12.4%)同时接受了全身化学治疗和免疫治疗。3年疾病特异性生存(DSS)率为41.6%(37/89),5年DSS率为31.5%(28/89)。多因素Cox比例风险回归模型分析结果显示,年龄≥70岁和T2期均为AMM患者预后的危险因素(HR=11.29、4.83,95%CI 2.89~44.13、1.66~14.11,P均<0.01),而神经脉管侵犯、免疫治疗、系统化学治疗联合免疫治疗广泛性局部切除后补充腹会阴切除、直接行腹会阴切除和腹会阴切除联合腹股沟淋巴结清扫均为预后的保护因素(HR=0.09、0.23、0.10、0.13、0.26、0.02,95%CI 0.02~0.34、0.10~0.57、0.02~0.49、0.03~0.52、0.08~0.90、0.00~0.27,P均<0.05)。进一步利用年龄、性别、肿瘤部位、T分期、远处转移、药物治疗和手术方式建立Nomogram预后预测模型,该Nomogram模型内部验证显示其在预测1、3和5年DSS方面表现出良好的准确性,一致性指数为0.749,较TNM系统一致性指数(0.607)高。结论AMM患者多<70岁,女性居多,肿瘤多位于直肠,接受免疫治疗的患者较多。年龄≥70岁和T2期是AMM患者预后的危险因素,神经脉管侵犯、以免疫治疗为主的综合治疗、广泛性局部切除后补充腹会阴切除、直接行腹会阴切除和腹会阴切除联合腹股沟淋巴结清扫是预后的独立保�Objective To analyze the influence of clinicopathological features on the prognosis of anorectal malignant melanoma(AMM),and to establish a more accurate prognosis prediction model.Methods From January 1,2006 to December 31,2018,at Fudan University Shanghai Cancer Center,the data of 89 patients diagnosed with AMM and underwent operation were retrospectively analyzed.The Cox proportional hazard regression model was used to analyze factors affecting the prognosis.Backward elimination was used to select variables,Nomogram prognosis prediction model was established and verified internally,and the consistency index was calculated.Results Among 89 AMM patients,65(73.0%)were female,78(87.6%)were<70 years old,and the most common tumor location was the rectum(48.3%,n=43),followed by the anal canal(31.5%,n=28)and the anorectal canal(20.2%,n=18).Thirty-eight(42.7%)patients directly received abdominal-perineal resection(APR),37 patients(41.6%)received interferon-based immunotherapy,and 11 patients(12.4%)received both systemic chemotherapy and immunotherapy.The 3-year disease-specific survival(DSS)rate was 41.6%(37/89),and the 5-year DSS rate was 31.5%(28/89).The results of multivariate Cox analysis showed that age≥70 years old and T2 stage were risk factors of the prognosis of AMM patients(hazard ratio(HR)=11.29,4.83;95%confidence interval(CI)2.89 to 44.13,1.66 to 14.11;both P<0.01),while neurovascular invasion,immunotherapy treatment,systemic chemotherapy combined with immunotherapy,APR after extensive local resection,directly APR and APR combined with inguinal lymphadenectomy were protective factors of the prognosis(HR=0.09,0.23,0.10,0.13,0.26,0.02;95%CI 0.02 to 0.34,0.10 to 0.57,0.02 to 0.49,0.03 to 0.52,0.08 to 0.90,0.00 to 0.27;all P<0.05).The Nomogram model was further established with age,gender,tumor location,T stage,distant metastasis,medication chemotherapy and surgical treatment.The results of the Nomogram model internal verification indicated that the accuracy of the model in predicting 1-year,3-year and 5-year

关 键 词：结直肠肿瘤 恶性黑色素瘤 预后 列线图 

分 类 号：R735.3[医药卫生—肿瘤]