2种活检方法对156例口腔黏膜恶性黑色素患者预后的影响  

Comparison of the effect of two kinds of biopsy on prognosis of oral mucosal malignant melanoma-a retrospective analysis of156cases

作　　者：韩如雪 马旭辉[1] 李智 任国欣[1] 郭伟[1] 吴云腾[1] 梁翔[3] HAN Ru-xue;MA Xu-hui;LI Zhi;REN Guo-xin;GUO-Wei;WU Yun-teng;LIANG Xiang(Department of Oromaxillofacial Head and Neck Oncology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,College of Stomatology,Shanghai Jiao Tong University,National Center for Stomatology,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology,Shanghai 200011;School of Stomatology,Weifang Medical College,Weifang 261021,Shandong Province;Department of Thoracic Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,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口腔颌面-头颈肿瘤科,上海交通大学口腔医学院,国家口腔医学中心,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200011 [2]潍坊医学院口腔医学院,山东潍坊261021 [3]上海交通大学医学院附属第九人民医院胸外科,上海200011

出　　处：《中国口腔颌面外科杂志》2022年第3期235-238,共4页China Journal of Oral and Maxillofacial Surgery

基　　金：上海市抗癌协会青年医生“雏鹰”计划(SACA-CY19C13);上海交通大学交叉医学(理)基金(ZH2018QNA09);上海交通大学医学院附属第九人民医院基础研究助推计划(JYZZ073);上海市交通大学医学院附属第九人民医院“精才培育项目”(JC202001)。

摘　　要：目的:比较2种活检方法在口腔黏膜恶性黑色素瘤(oral mucosal melanoma,OMM)中的预后差异,以期找到OMM最佳的活检模式。方法:回顾分析2010年1月—2018年1月于上海交通大学医学院附属第九人民医院确诊的OMM病例,比较2种活检方法与预后的关系。主要观察指标为生存期(overall survival,OS),即病理确诊到死亡日期或随访时间节点(2021年9月1日)。采用SAS 9.3软件包进行统计学分析。结果:单因素分析显示,T分期、颈淋巴结(CLN)状况、活检类型与OS有统计学相关性。所有3个变量均纳入Cox回归模型中进行多因素分析,结果显示,T分期、颈部淋巴结转移以及活检方法与预后有显著相关性。冷冻活检组颈部淋巴结和远处转移的发生率均显著低于切取活检组(53%∶74%和22%∶42%,Log-rank=12.955,P<0.01);冷冻活检组的3年和5年OS显著高于切取活检组(65%∶42%,Log-rank=12.570,P<0.01;54%∶20%,Log-rank=7.203,P<0.01)。结论:冷冻活检组3年及5年OS显著优于切取活检组,冷冻下活检较常规切取活检能显著降低OMM的颈淋巴结及远处转移率。推荐采用冷冻下活检,用以明确OMM的诊断。PURPOSE:To compare the effect of two kinds of biopsy on prognosis of oral mucosal malignant melanoma(OMM),in order to find an optional biopsy method for OMM.METHODS:Patients with OMM treated at Shanghai Ninth Hospital,Shanghai Jiao Tong University School of Medicine from Jan.2010 to Jan.2018 were retrospectively analyzed.Correlation between biopsy methods and prognosis were explored.Overall survival(OS)was the primary outcome,and OS was the time from pathological diagnosis to the date of death or follow-up(September 1,2021).SAS 9.3 software was used for statistical analysis.RESULTS:Univariate analysis showed that T stage,cervical lymph node(CLN)status,biopsy type and OS were statistically correlated.All the three variables were included in Cox regression model for multivariate analysis.The results showed that T stage,CLN and biopsy type were independent prognostic factors of OS(P<0.05).CLN and biopsy methods were identified as prognostic factors.Incidences of CLN and distant metastasis were both significantly less in cryogenic biopsy group than in incisional biopsy group(53%vs.74%and 22%vs.42%,Log-rank=12.955,P<0.01 respectively).The 3-and 5-year OS was significantly longer in cryogenic biopsy group than in incisional biopsy group(65%vs.42%,Log-rank=12.570,P<0.01 and 54%vs.20%,Log-rank=7.203,P<0.01,respectively).CONCLUSIONS:The 3-and 5-year OS in cryogenic biopsy group was significantly better than that in the incisional biopsy group.Cryogenic biopsy could significantly reduce CLN and distant metastasis of OMM.Therefore,Use of cryogenic biopsy instead of incisional biopsy to clarify the diagnosis of OMM is recommended.

关 键 词：口腔 黏膜黑色素瘤 冷冻治疗 切取活检 

分 类 号：R739.8[医药卫生—肿瘤]