治疗方式对肛管直肠恶性黑色素瘤预后的影响

Effects of different surgical modalities on the prognosis of primary anorectal malignant melanoma

目的探讨不同治疗方式对肛管直肠恶性黑色素瘤的预后影响。方法回顾性分析1965--2007年收治的60例肛管直肠恶性黑色素瘤患者的临床资料，并对预后进行生存分析和COX风险因素分析。结果60例患者中，肿瘤发生于直肠者50例，发生于肛管者10例。53例行手术切除治疗。对行单纯手术的23例患者和术后辅助化疗、放疗、生物治疗等综合治疗的30例患者的资料进行生存分析，总生存率差异无统计学意义（χ^2=0．078，P〉0．05）。53例手术病例中，37例行Miles术，16例行局部扩大切除术，两种术式生存分析差异无统计学意义（χ^2=1．464，P〉0．05）。风险因素分析结果提示，肿瘤浸润深度为危险因素，治疗方式为保护因素。结论手术切除是肛管直肠恶性黑色素瘤的主要治疗手段，对肛管直肠恶性黑色素瘤病变局限者，应首选局部扩大切除术；病变深度和治疗方式是影响预后的风险因素。

Objective To investigate the effects of different surgical modalities on primary anorectal malignant melanoma. Methods Clinical data of 60 primary anorectal malignant melanoma cases who were admitted between 1965 and 2007 were collected, summarized and analyzed. Multivariate analysis was performed using the COX proportional hazards regression method. Results Tumors located in the rectum in 50 cases, in the anal canal in 10 cases. The overall survival rates were not significantly different between the 23 cases who received tumor resection only and those 30 cases receiving postoperative adjuvant therapy （ χ^2 = 0. 078, P 〉 0. 05 ）. Among these 53 surgical cases of anorectal malignant melanoma, 37 underwent abdominoperineal resection, 16 underwent wide local excisions, There was no significant difference of the survival rates between the two groups （ χ^2 = 1. 464, P 〉 0. 05 ）. Risk factors analysis revealed that the depth of tumor invasion is a risk factor （ P 〈 0. 05 ）, the modality of treatment is a protective factor （ P 〈 0. 05 ）. Conclusions Surgical operation is the principal effective management for anorectal malignant melanoma, Wide local excision is the principal therapeutic choice for localized wellcircumferential anorectal malignant melanomas.