皮肤恶性黑色素瘤患者预后的影响因素分析

Analysis of factors influencing the prognosis of patients with cutaneous malignant melanoma

目的分析皮肤恶性黑色素瘤(MM)患者预后的影响因素。方法选取74例接受手术联合免疫治疗的皮肤MM患者,采用Cox比例风险回归模型分析影响皮肤MM患者预后的危险因素。结果 74例皮肤MM患者中,死亡33例。单因素分析结果显示,不同TNM分期、肿瘤破溃情况、淋巴结转移情况、Clark分级皮肤MM患者的2年生存率比较,差异均有统计学意义(P<0.05);不同病理类型皮肤MM患者的2年生存率比较,差异无统计学意义(P>0.05)。Cox比例风险回归模型分析结果显示,TNM分期为Ⅲ～Ⅳ期、有淋巴结转移、有肿瘤破溃、Clark分级为Ⅲ～Ⅴ级是影响手术联合免疫治疗后皮肤MM患者预后的独立危险因素(P<0.01)。结论手术联合免疫治疗对皮肤MM具有较好的效果,临床上应重视患者的TNM分期、淋巴结转移情况、肿瘤破溃情况和Clark分级对皮肤MM患者预后的影响。

Objective To analyze the influenceing factors of prognostic for patients with cutaneous malignant melanoma (MM). Method The clinical data of 74 cutaneous MM patients who received surgery and immunotherapy were analyzed in the research, Cox proportional hazards regression model was used to analyze the risk factors affecting the prognosis of patients with cutaneous MM. Result Of the 74 cases of cutaneous MM, 33 died during follow-up. Univariate analysis found that, different clinical stages, tumor rupture, lymph node metastasis and Clark classification were associated with varying 2-year survival rates among cutaneous MM patients, and the differences were statistically significant (P< 0.05);while the 2-year survival rates were similar in those who with different pathological types (P>0.05). Cox proportional hazard regression model analysis indicated that, TNM stage of III-IV, positive lymph node metastasis, presence of tumor rupture, Clark classification of III-V were independent risk factors for cutaneous MM patients after surgery combined with immunotherapy (P<0.01). Conclusion Surgery combined with immunotherapy are fairly effective for cutaneous MM and the influence of clinical stage, lymph node metastasis, tumor rupture, and Clark classification on the lesions and prognosis of patients should be addressed in clinical practice.