肢体隔离热灌注化疗治疗肢端恶性黑色素瘤预后的多因素分析  

Multivariate analysis of prognosis of hyperthermic isolated limb perfusion chemotherapy for acral malignant melanoma

作　　者：李廷栋 尹晓慧[2] 徐文红 付来华 甘雨灵 刘利兵 梁福东 齐江华[1] 梁鹏[1] 李晶[1] 宋建民 潘东升[1] LI Tingdong;YIN Xiaohui;XU Wenhong;FU Laihua;GAN Yuling;LIU Libing;LIANG Fudong;QI Jianghua;LIANG Peng;LI Jing;SONG Jianmin;PAN Dongsheng(Department of Bone and Soft Tissue Oncology,Gansu Provincial Cancer Hospital,Gansu,Lanzhou 730050,China;DepartmentⅡof Acupuncture and Moxibustion,Gansu Provincial Hospital of Traditional Chinese Medicine,Gansu,Lanzhou 730050,China;Department of Rehabilitation,Gansu Dearjoy Rehab Hospital,Gansu,Lanzhou 730050,China;National Cancer Center,National Clinical Research Center for Cancer,Shenzhen Hospital,Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Guangdong,Shenzhen 518116,China;Department of Bone and Soft Tissue Oncology,Gansu Provincial Hospital,Gansu,Lanzhou 730000,China)

机构地区：[1]甘肃省肿瘤医院骨与软组织肿瘤科,甘肃兰州730050 [2]甘肃省中医院针灸二科,甘肃兰州730050 [3]甘肃达尔健康复医院康复科,甘肃兰州730050 [4]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院,北京协和医学院肿瘤医院深圳医院,广东深圳518116 [5]甘肃省人民医院骨与软组织肿瘤科,甘肃兰州730000

出　　处：《中国医药科学》2023年第13期4-8,16,共6页China Medicine And Pharmacy

基　　金：甘肃省卫生行业科研计划项目(GSWSKY-2014-16)。

摘　　要：目的探讨影响肢端恶性黑色素瘤进行肢体隔离热灌注化疗预后的相关因素。方法回顾性分析2006年11月至2017年10月甘肃省肿瘤医院骨与软组肿瘤科行手术切取病灶经病理证实并应用顺铂行肢体隔离热灌注化疗的肢端恶性黑色素瘤患者41例的临床资料,包括年龄、性别、身高、原发灶部位、溃疡、Breslow厚度、Clark分级、淋巴结转移情况及病理分期等相关因素。采用R 4.2.2软件对数据进行统计学分析。采用LASSO回归和逐步双向单因素Cox回归筛选变量,分别将热灌注化疗剂量、身高、病理TNM分期、切缘、有丝分裂指数[总生存期(OS)];热灌注化疗剂量,身高,病理TNM分期,有丝分裂指数[无进展生存期(PFS)]纳入多因素后续多因素Cox回归,筛选独立预后因素,并以森林图展示。通过Kaplan-Meier生存曲线,展示患者术后累计生存率,通过Log-Rank检验比较高、低热灌注化疗剂量对患者生存率的影响。结果基于41例肢体隔离热灌注化疗治疗恶性黑色素瘤患者的临床资料进行LASSO回归,分别将以下变量纳入模型:热灌注化疗剂量、身高、病理TNM分期、远处转移、切缘、有丝分裂指数(OS、PFS)。进一步逐步双向单因素Cox回归及因素Cox回归分析表明:热灌注化疗剂量、身高、病理TNM分期是OS的独立预后因素(P<0.05);热灌注化疗剂量和病理TNM分期是PFS的独立预后因素(P<0.05)。高剂量热灌注化疗可以提高术后患者生存率,晚期恶性黑色素瘤患者术后生存率较低。结论本研究对肢端恶性黑色素瘤患者行肢体隔离热灌注化疗的生存情况进行多因素分析提示:顺铂高剂量区域热灌注化疗能够显著提高患肢术后生存率。肢体隔离热灌注化疗剂量、身高、病理分期是OS独立预后因素,肢体隔离热灌注化疗剂量、病理分期为PFS独立预后因素。Objective To explore the related factors that affect the prognosis of hyperthermic isolated limb perfusion chemotherapy for acral malignant melanoma.Methods Retrospective analysis was performed on the clinical data of 41 patients with acral malignant melanoma who had undergone surgical resection of the lesion,confirmed by pathology and treated with cisplatin,and received hyperthermic isolated limb perfusion chemotherapy in the Department of Bone and Soft Tissue Oncology,Gansu Provincial Cancer Hospital from November 2006 to October 2017,including age,gender,height,location of the primary focus,ulcer,Breslow thickness,Clark grade,lymph node metastasis,pathological stage and other related factors.Statistical analysis of the data was conducted using R 4.2.2 software.LASSO regression and stepwise bidirectional univariate Cox regression were used to screen variables,and the dose of hyperthermic perfusion chemotherapy,height,pathological TNM stage,surgical margin,and mitotic index(overall survival[OS]);the dose of hyperthermic perfusion chemotherapy,height,pathological TNM stage,mitotic index(progression-free survival[PFS])were included in the multivariate follow-up multivariate Cox regression,respectively,and independent prognostic factors were screened,and displayed in the forest map.By using the Kaplan Meier survival curve,the cumulative postoperative survival rate of patients was displayed,and the impact of high and low doses of hyperthermic perfusion chemotherapy on patient survival rate was compared through the Log Rank test.Results Based on the clinical data of 41 patients with malignant melanoma treated by hyperthermic isolated limb perfusion chemotherapy,LASSO regression was performed,and the following variables were included in the model:hyperthermic perfusion chemotherapy dose,height,pathological TNM stage,distant metastasis,surgical margin,mitotic index(OS,PFS).Further,the stepwise bidirectional univariate Cox regression analysis and multivariate Cox regression analysis showed that the dose of hyperthermic

关 键 词：肢端黑色素瘤 肢体隔离热灌注 预后 多因素分析 

分 类 号：R739.5[医药卫生—肿瘤]