232例晚期黏膜黑色素瘤患者的一二线治疗疗效及预后影响因素

Curative effect of the 1^(st) line and the 2^(nd) line therapies for the 232 patients with advanced mucosal melanoma and factors efecting prognosis of the patients

目的:探讨晚期黏膜黑色素瘤(mucosal melanoma,MM)患者的临床特征、治疗及预后影响因素。方法:收集2008年1月至2015年12月北京肿瘤医院肾癌黑色素瘤内科收治的232例晚期MM患者的临床资料,一二线治疗方案,对患者生存情况进行随访,并对影响总生存期的多因素预后进行分析统计。结果:本组晚期MM患者共232例(男101、女131例),中位年龄56.0岁;原发部位:直肠肛管29.3%,鼻腔25.0%,泌尿生殖道20.7%,口腔20.3%,食管4.7%;就诊时M分期:M1a 17.2%,M1b 21.6%,M1c 61.2%;多数患者存在多处转移,常见转移部位为肺50.4%、肝34.9%、骨23.3%。中位PFS:一线治疗方案患者4.5个月,二线治疗方案患者2.5个月。所有患者中位OS为11.0个月,其中M1a期16.0个月、M1b期14.0个月、M1c期10.0个月。预后分析发现,就诊时M分期和血清LDH与OS显著相关(P<0.01),与原发灶部位、性别、年龄、基因突变状态等无显著相关性。结论:鼻腔、口腔是MM的好发部位,就诊时M分期、LDH水平是OS的独立预后因素。

Objective：To explore clinical features of the patients with advanced mucosal melanoma （MM） and effect factors on therapy and prognosis of the patients.Methods：Clinical data and regimens for the 1 st line and the 2nd line therapies of 232 patients with advanced MM who were hospitalized in Department of Renal Cancer and Melanoma,Peking University Cancer Hospital during January 2008 to December 2015 were collected.Survival status of the patients were followed up,and multiple factors that effect on overall survival and prognosis of the patients were statistically analyzed.Results：There were 232 patients with advanced MM in this study （101 male,131 female）.Median age of the patients was 56 years old;anatomic sites of the primary melanoma were anorectum （29.3％）,nasal cavity （25.0％）,urogenital tract （20.7％）,oral cavity （20.3％）,esophagus （4.7％）,M staging at visiting time of the patients were 17.2％ as M1a,21.6％ as M1b,61.2％ as M1c;Most patients had multiple metastases,most common metastic sites of the primary melanoma were lung （50.4％）,liver （34.9％）,bone （23.3％）;median progression free survival （mPFS） was 4.5 months in the patients received the 1 st line therapy and 2.5 months in the patients received the 2nd line therapy;overall survival （OS） was 11.0 months in all of the patients,and among them,OS was 16.0 months in the patients as M1a stage,14.0 months in the patients as M1b stage,10.0 months in the patients as M1c stage.Prognosis analysis found that OS was significantly correlated with M staging at visiting time and serum lactate dehydrogenase （LDH） （P ＜0.01） and did not obviously correlated with anatomic sites of the primary melanoma,gender,age,gene mutation status of the patients.Conclusion：Nasal and oral cavities could be predilection sites of the MM.M staging at the visiting time of the patients and the serum LDH level could be dependent prognosis factor of OS.