大剂量干扰素治疗是黑素瘤术后辅助治疗的首选方案(附450例观察)

High-dose interferon is the first choice for postoperative adjuvant therapy of melanoma patients:An observation of 450 samples

目的:回顾分析黑素瘤患者术后辅助治疗的临床资料,评价不同的术后辅助治疗方案对患者无病生存(disease-free survival,DFS)的影响。方法:收集2006年1月至2009年7月我科就诊的450例Ⅰ至Ⅲ期恶性黑素瘤患者(来自全国28个省市,男239、女211例,年龄12～85岁,中位年龄51岁)的临床资料。所有患者均接受手术治疗,术后辅助治疗包括大剂量干扰素治疗(2 200万IU静注,每周5次,共4周;900万IU皮下注射,每周3次,共11个月)、化疗(方案以达卡巴嗪或替莫唑胺为主,也有联合顺铂、紫杉醇、长春新碱等药物的方案)、化疗联合放疗和单纯放疗(原发灶或淋巴结引流区域放疗,剂量40～60 Gy)等4个方案。结果:450例Ⅰ至Ⅲ期恶性黑素瘤患者,分别行原发病灶的局部切除、扩大切除或扩大切除联合区域淋巴结切除。术后184例患者未接受任何治疗、84例患者接受了化疗、25例患者接受了联合放化疗、2例患者接受了单纯放疗,该4组患者的中位DFS分别为13个月、20个月、29个月、23个月;而155例接受了大剂量干扰素治疗患者的中位DFS尚未达到。化疗的不良反应主要为消化道不良反应、骨髓抑制、肝功能损伤等;干扰素治疗的不良反应主要有白细胞降低、发热、乏力、转氨酶升高、厌食,其中白细胞降低以及转氨酶升高达3或4级不良反应的发生率分别为15%和10%;经对症处理后,患者的不良反应均恢复正常。结论:Ⅰ至Ⅲ期恶性黑素瘤患者的手术切除方式以及术后辅助治疗的方案对于患者的DFS极为重要,术后接受大剂量干扰素治疗延长恶性黑素瘤患者DFS的效果最好,且安全性较好。

Objective： To retrospective study the clinical characteristics of melanoma patients receiving adjuvant therapy after surgery and to evaluate their disease-free survival（DFS） after different treatment options.Methods： Four hundred and fifty patients with malignant melanoma（stageⅠ to Ⅲ）,who had received surgery in our center from January 2006 to July 2009,were included in the present study.The patients were from 28 cities,including 239 males and 211 females,with an age range of 12-85 years.After surgery,the patients received different adjuvant therapies,including high-dose interferon treatment（interferon 22 000 000 IU iv.5 times a week for 4 weeks,or 9 000 000 IU sc.3 times a week for 11 months）,chemotherapy（most cases were treated with dacarbazine or temozolomide;some were treated with cisplatin,paclitaxel and vincristine combination）,radiochemotherapy,or radiotherapy（primary tumors or tumor-draining lymph nodes,40-60 Gy）.Results： The surgical options included local resection of the primary lesion,expanded resection of the primary lesion,and extended resection and removal of regional lymph node.The median DFS were 15 months,24 months and 13 months,respectively.Totally 184 patients did not receive any treatment after surgery,84 received chemotherapy,25 received radiochemotherapy,and 2 received radiotherapy;their median DFS were 13 months,20 months,29 months and 23 months,respectively.Totally 155 patients received high-dose interferon treatment and the median DFS was not reached.The side effects of chemotherapy included gastrointestinal side effects,bone marrow suppression and liver damage.The side effects of high-dose interferon included leukopenia,fever,fatigue,increased aminotransferase and anorexia.The incidences of severe leukopenia and increased aminotransferase（reaching 3 or 4 degree） were 15% and 10%,respectively.All patients returned to normal after symptomatic treatment.Conclusion： Surgical resection and adjuvant therapy strategy are extremely important for DFS of patients with malignant melanoma in stageⅠ to Ⅲ.The best DFS can be obtained in malignant melanoma patients who receive high-dose interferon therapy after surgery,with better safety.