44例原发性鼻粘膜恶性黑色素瘤的临床特征及预后分析

Clinical Characteristics and Prognosis of Primary Nasal Mucosal Melanoma——A Report of 44 Cases

背景与目的:原发性鼻粘膜恶性黑色素瘤是一种罕见肿瘤,其临床资料主要来源于西方人群。本文总结原发性鼻粘膜恶性黑色素瘤患者的临床资料,分析其临床特征和影响预后的因素。方法:回顾性分析1971年1月至2005年7月中山大学肿瘤防治中心收治的原发性鼻粘膜恶性黑色素瘤66例,其中有完整随访资料的44例。复习病历登记的临床表现和治疗方法,信件或电话随访记录肿瘤复发和患者生存情况。用Kaplan-Meier方法计算生存率,用Cox比例风险模型进行多因素分析。结果:44例有完整随访资料的患者中,37例原发于鼻腔粘膜,5例原发于副鼻窦粘膜,2例原发于鼻咽粘膜。初治时12例患者出现颈淋巴结转移。31例接受以手术为主的治疗,其中8例接受辅助性放疗,13例接受辅助性化疗,6例接受辅助性非特异性免疫治疗。中位随访时间29个月,局部复发率为54.5%(24例),10例(22.7%)患者发生颈淋巴结转移复发,11例(25%)发生远处转移。中位生存时间为24个月,5年生存率为25%。预后分析显示,临床分期影响患者5年生存率,而性别、年龄、原发肿瘤部位、原发肿瘤大小、是否接受辅助治疗与5年生存率无关。结论:原发性鼻粘膜恶性黑色素瘤局部复发率和远处转移率高,且易出现颈淋巴结转移。临床分期影响患者5年生存率。

BACKGROUND ＆ OBJECTIVE- Primary mucosal malignant melanoma of the nasal cavity, paranasal sinuses, and nasopharynx is rare and current research data of this disease are mainly from western populations. This study was to analyze the clinical characteristics of this disease and prognositic factors. METHODS. From Jan. 1971 to Jul. 2005, 66 patients with primary nasal mucosal melanoma were treated in Cancer Center of Sun Yat-sen University, China. Demographics and baseline characteristics, treatments, recurrence, metastasis, and survival were documented in hospital records. All records of these patients were analyzed retrospectively. Kaplan-Meier method was used to calculate survival rate; Cox model was used to analyze prognostic factors. RESULTS. Among 44 evaluable cases, 37 were originated from the nasal cavity, 5 from the paranasal sinuses, and 2 from the nasopharynx. Cervical lymphadenopathy at initial presentation occurred in 12 patients. Of the 31 patients received operation-dominated treatment, 8 received adjuvant radiotherapy, 13 received adjuvant chemotherapy, and 6 received adjuvant non-specific immunotherapy. The median time of follow-up was 29 months. Local recurrence, cervical lymphadenopathy, and distant metastasis occurred in 24, 10, and 11 patients, respectively, during follow-up. The median survival time was 24 months and the 5-year survival time was 25%. Clinical stage affected prognosis, whereas age, gender, site, primary tumor mass, and adjuvant therapy were not correlated to survival status. CONCLUSION. Nasal mucosal melanoma has high incidence of local recurrence and distant metastasis, especially cervical lymphadenopathy. Clinical stage affects the prognosis.