Ⅲ期恶性黑色素瘤的综合治疗及临床病理参数对DFS的影响

Integrated treatment of stage 3 malignant melanoma and effects of clinicopathological indices on disease-free survival

目的：评价不同术后辅助治疗方案及临床病理参数对Ⅲ期恶性黑色素瘤患者无病生存（DFS）的影响.方法：收集2006年1月至2012年1月新疆医科大学附属肿瘤医院收治的130例Ⅲ期恶性黑色素瘤患者的临床资料,患者均接受规范的手术治疗,分为3组：（1）氮烯咪胺组：42例为（2006-2009年）,患者接受氮烯咪胺（400 mg,d1-4,4～6个周期;）（2）干扰素组：63例（2009-2012年）,患者接受大剂量干扰素治疗（α-2b干扰素,2 200万U静脉输注,每周5次,共4周,900万U皮下注射,每周3次,共11个月）;（3）未治疗组（25例）：因经济等问题术后未接受任何治疗.结果：随访时间为4～76个月,中位随访时间31个月.氮烯咪胺组、干扰素组、未治疗组患者DFS分别为（31.0±2.5）月、（24.0±1.8）月、（15.1±1.3）月.3组比较,差异有统计学意义（P＜0.05）.接受辅助治疗者DFS较未接受辅助治疗者长;大剂量干扰素治疗延长DFS最为显著（P＜0.05）.年龄、病理类型、原发灶厚度、有无溃疡等因素均不影响DFS（P＞0.05）.结论：Ⅲ期黑色素瘤患者,常见临床病理参数对DFS无影响,治疗应以规范综合治疗为主,大剂量干扰素治疗可延长恶性黑素瘤患者DFS,效果及安全性较好,值得推广.

Objective：To examine the effects of different postoperative adjuvant therapeutic protocols and clinieopathological indices on the disease-free survival （ DFS ） in patients with stage 3 malignant melanoma. Methods ： We recruited 130 patients with stage 3 malignant melanoma from Affiliated Cancer Hospital of Xinjiang Medical University between January 2006 and January 2012. All patients were treated with, following formal surgeries, decarbazine （400rag at days 1 to 4 for 4 -6 cycles） （n =42, between January 2006 and January 2009, high-dose interferon （ 22 million units of α-2b interferon with 5 courses per week for 4 weeks followed by 9 million units with 3 courses per week for 11 months） （n = 63, between January 2009 and January 2012） or nil treatment group （n = 25 ） for sake of poor economic conditions. Results： After a foflow-up period of 4 to 76 months （median： 31 Months）, the decarbazine, high-dose interferon and nil treatment group yielded the DFS of （ 31.0 ± 2.5 ）, （ 24.0 ± 1.8 ） and （ 15.1±1.3 ） months （ P 〈 0.05 ）. Patients treated with either medication, in particular, the high-dose interferon group, had a prolonged DFS compared with those without. The age, pathological classifications, thickness of primary lesion and presence of ulceration did not have an influence on the DFS （ all P 〉 0. 05 ）. Conclusion： The common clinicopathological indices do not have a significant influence on the stage 3 malignant melanoma. Integrated therapeutic protocol should be recommended as a regular therapy. High-dose interferon may prolong the duration of DFS, which gives rise to preferable outcomes and safety profiles, rendering it worthwhile for clinical application.