52例原发鼻腔鼻窦黏膜恶性黑色素瘤疗效分析

Treatment outcome of primary mucosal melanoma of the nasal cavity and paranasal sinuses：an analysis of 52 patients

目的：分析原发鼻腔鼻窦恶性黑色素瘤疗效及放疗在其治疗中作用。方法回顾分析2001—2014年间我院收治原发鼻腔鼻窦恶性黑色素瘤52例临床资料，其中单纯手术18例，手术联合放疗31例（手术＋术后放疗24例、术前放疗＋手术7例），单纯放疗3例。使用倾向配比评分法对手术联合放疗组与单纯手术组配对分析。中位随访时间59个月。全组5年LC、DMFS、DFS、OS分别为49％、48％、22％、45％。配对后手术联合放疗5年LC 明显高于单纯手术（88％∶43％，P＝0．028），但5年DMFS相近（67％∶57％，P＝0．955）、DFS相近（58％∶24％，P＝0．131）、5年OS也相近（67％∶67％， P＝0．727）。术前放疗＋手术组、手术＋术后放疗组手术切缘阴性率分别为100％和50％（ P＝0．004）。结论手术联合放疗可提高原发鼻腔鼻窦恶性黑色素瘤LC率，术前放疗增加手术切缘阴性率。

Objective To investigate the treatment outcome of primary mucosal melanoma of the nasal cavity and paranasal sinuses and the role of radiotherapy in the treatment of this disease .Methods The clinical data of 52 patients with primary mucosal melanoma of the nasal cavity and paranasal sinuses who were admitted to our hospital from 2001 to 2014 were analyzed retrospectively.Among these patients, 18 received surgery alone, 31 received surgery combined with radiotherapy （ 24 received surgery and postoperative radiotherapy and 7 received preoperative radiotherapy and surgery ） , and 3 received radiotherapy alone.The surgery＋radiotherapy group and the surgery group were matched using propensity score matching.Results The median follow-up was 59 months.The 5-year local control （ LC）, distant metastasis-free survival （DMFS）, disease-free survival （DFS）, and overall survival （OS） of all patients were 49%, 48%, 22%, and 45%, respectively.After matching, the surgery＋radiotherapy group had a significantly higher LC than the surgery group （88%vs.43%, P=0.028）, but the two groups had similar 5-year DMFS （67%vs.57%, P=0.955）, 5-year DFS （58%vs.24%, P=0.131）, and 5-year OS （67%vs. 67%, P=0.727 ） .The negative margin rates in the preoperative radiotherapy＋surgery subgroup and the surgery＋postoperative radiotherapy subgroup were 100%and 50%, respectively （ P=0.004） .Conclusions Surgery combined with radiotherapy can improve the LC rate in patients with primary mucosal melanoma of the nasal cavity and paranasal sinuses, and preoperative radiotherapy can increase the negative margin rate.