180例原发性食管恶性黑色素瘤的临床病理特征  

Clinical pathological features of 180 cases with primary esophageal malignant melanoma

作　　者：孟辉[1] 赵学科[1] 宋昕[1] 韩文莉 周胜理 孙莉[1] 胡守佳[1] 程让[1] 王敏[1] 尹玉慧[3] 李宜真 丁一 王立东[1] Meng Hui;Zhao Xueke;Song Xin;Han Wenli;Zhou Shengli;Sun Li;Hu Shoujia;Cheng Rang;Wang Min;Yin Yuhui;Li Yizhen;Ding Yi;Wang Lidong(State Key Laboratory of Esophageal Cancer Prevention&Treatment,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Pathology,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Department of Pathology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Medical Science Institute of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院省部共建食管癌防治国家重点实验室,450052 [2]河南省人民医院病理科,郑州450003 [3]郑州大学第一附属医院病理科,450052 [4]郑州大学医学科学院,450052

出　　处：《中华肿瘤杂志》2021年第9期949-954,共6页Chinese Journal of Oncology

基　　金：国家自然科学基金(81872032);河南省医学科技攻关研究计划(2018020006)。

摘　　要：目的探讨原发性食管恶性黑色素瘤(PMME)的临床病理特征和流行病学特征。方法收集1973—2016年河南省食管癌重点开放实验室食管癌数据库中180例PMME患者的临床病理资料,其中男136例,年龄(58.5±9.0)岁;女44例,年龄(56.7±12.2)岁。生存分析采用Kaplan-Meier法和Log rank检验,多因素分析采用Cox回归比例模型。结果PMME的发病率为0.036%(180/50万),大多为男性患者(男女比例约为3∶1)。PMME常见的发病部位为食管下段(48.9%,85/174),其次为食管中段(46.0%,80/174)和食管上段(5.2%,9/174)。3例患者PMME细胞显微镜下未见黑色颗粒,且其免疫组化示Melan-A和HMB45呈强阳性。129例行术前食管活检的患者中,69例未被确诊为PMME(53.5%)。全组患者的中位生存时间为7.9个月,1、2、3和5年生存率分别为25.0%、7.9%、6.6%和1.3%。单因素分析显示,N分期、M分期、TNM分期和放疗与患者的总生存有关(均P<0.05);多因素分析显示,TNM分期和放疗为患者总生存的独立影响因素(均P<0.05)。结论PMME多发于男性,常见发病部位为食管下段,中国人群PMME术前漏诊率较高;TNM分期和放疗为影响患者总生存的独立影响因素。Objective To investigate the clinical pathological and epidemiological characteristics of primary esophageal malignant melanoma(PMME).Methods The clinical pathology data of 180 PMME patients in the esophageal cancer database of the key laboratory of esophageal cancer research in Henan Province from 1973 to 2016 were collected,of which 136 were male,aged(58.5±9.0)years,44 were female,aged(56.7±12.2)years.Kaplan-Meier and Log rank test were used for survival analysis,Cox regression scale model was used for risk factor analysis.Results The incidence of PMME is 0.036%(180/500,000),mostly were male(about 3∶1 for men:female).The common sites of PMME were the lower part of the esophagus(48.9%,85/174),followed by the middle section of the esophagus(46.0%,80/174)and the upper part of the esophagus(5.2%,9/174).No black particles were seen in the PMME cells of 3 patients under microscope,and strong positive expressions of Melan-A and HMB453 were observed in these 3 patients by immunohistochemical results.Of the 129 patients who had a routine preoperative esophageal biopsy,69 were undiagnosed with PMME(53.5%).The medium survival time of the whole group was 7.9 months,and the survival rates of 1,2,3,5 years were 25.0%,7.9%,6.6%and 1.3%,respectively.The univariate analysis showed that N,M,TNM phase and radiotherapy were related to the overall survival of patients(P<0.05).Multivariate analysis showed that TNM phase and radiotherapy were the independent risk factors for overall survival of patients(P<0.05).Conclusions PMME is more common in men,the common site of the disease is the lower part of the esophagus.The preoperatively missed diagnosis rate of Chinese PMME is high.TNM phase and radiotherapy are the independent risk factors for overall survival of patients.

关 键 词：食管肿瘤 恶性黑色素瘤 流行病学分析 确诊率 多发结节 

分 类 号：R735.1[医药卫生—肿瘤]