肢端黑色素瘤的远处转移特征和影响因素分析  

Analysis of feature and influencing factor of distant metastasis in acral melanoma

作　　者：魏晓婷 毛丽丽[1] 白雪[1] 郭军[1] 斯璐[1] WEI Xiaoting;MAO Lili;BAI Xue;GUO Jun;SI Lu(Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing 100142, China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所黑色素瘤与肉瘤内科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《临床肿瘤学杂志》2022年第5期405-410,共6页Chinese Clinical Oncology

基　　金：国家自然科学基金资助项目(81972566)。

摘　　要：目的 分析肢端黑色素瘤(AM)患者的远处转移特征及影响因素。方法 回顾性收集2000年1月1日至2017年12月31日北京大学肿瘤医院收治的AM患者的临床资料。采用Kaplan-Meier法绘制远处转移时间(TTDM)生存曲线,生存比较采用Log-rank检验,采用Cox比例风险回归模型分析发生远处转移的影响因素。结果 共纳入656例AM患者,48.3%的患者在治疗过程中发生了远处转移,肺和非区域淋巴结是最常见的转移部位。全组患者的中位TTDM为72.0个月(95%CI:56.1~105.0个月)。初始诊断分期为Ⅰ、Ⅱ、Ⅲ期患者的中位TTDM分别为未达到、72.0个月和17.0个月,差异有统计学意义(P<0.001)。单因素分析结果显示,初始诊断分期、辅助治疗、原发部位和溃疡状态与AM患者的TTDM有关(P<0.05)。考虑到Breslow厚度的预后作用和Kaplan-Meier曲线特征,也将其纳入后续的多因素Cox回归分析。多因素分析结果显示,初始诊断分期、Breslow厚度和原发部位是影响AM患者发生远处转移的独立预后因素(P均<0.05)。结论 临床实践中应重点关注影响AM患者发生远处转移的因素,即初始诊断分期、Breslow厚度和原发部位,对高危患者进行早期干预和严密随访,以改善预后。Objective To analyze the feature and influencing factor of distant metastasis in acral melanoma(AM)patients.Methods Clinical data of AM patients diagnosed with non-distant metastasis in Peking University Cancer Hospital during January 1,2000 and December 31,2017 were retrospectively collected.Kaplan-Meier method was used to draw the survival curve of time to distant metastasis(TTDM).Log-rank test was used for survival comparison,and Cox proportional hazards regression model was used to analyze the influencing factors of distant metastasis.Results A total of 656 AM patients were enrolled in this study.Distant metastases occurred during treatment in 48.3%patients and the most common metastatic sites were lung and lymph node.The overall median TTDM was 72.0 months(95%CI:56.1-105.0).The median TTDM of patients with stageⅠ,ⅡandⅢwere not reached,72.0 and 17.0 months,respectively,with significant difference(P<0.001).Univariate analysis showed that factors of initial clinical stage at diagnosis,adjuvant therapy,primary site and ulcer status were all statistically significant(P<0.05).Breslow thickness was also included in the subsequent multivariable analysis considering its prognostic value and the feature of Kaplan-Meier curves.Multivariable Cox regression results showed that the statistically significant influencing factors on distant metastasis were initial clinical stage at diagnosis,Breslow thickness and primary site(all P<0.05).Conclusion Influencing factors of distant metastasis for AM patients,i.e.,initial clinical stage at diagnosis,Breslow thickness and primary site should be closely monitored in clinical practice.As for patients with high-risk disease,early intervention and follow-up should be performed to improve patients'prognosis.

关 键 词：肢端黑色素瘤 远处转移 特征 影响因素 

分 类 号：R739.5[医药卫生—肿瘤]