肢端恶性黑色素瘤临床特征及预后因素分析

Analysis of clinical characteristics and prognostic factors of acral melanoma

背景与目的:在中国,黑色素瘤常见于肢端,预后较差。该研究分析肢端黑色素瘤(acral melanoma,AM)的临床特征、治疗方法及疗效,探究不良预后的相关因素。方法:回顾性收集中南大学湘雅医学院附属肿瘤医院2010年1月-2017年12月收治的322例AM患者的临床资料,分析临床特征及预后影响因素。结果:AM多见于农民(66%)及工人(12%),70.5%的病灶位于足底;男女比例为1.3∶1.0,中位年龄58岁,在湖南省各地区分布无明显差异;局部物理刺激及炎症刺激与AM发生密切相关;Ⅱ~Ⅲ期患者接受规范外科手术治疗者预后明显优于未行手术治疗者;相比于腓肠神经营养血管皮瓣,足底内侧动脉皮瓣修复足底病灶术后皮瓣坏死感染率较低;术后接受全身辅助治疗的患者出现远处转移的时间较未行辅助治疗者延长;接受化疗的Ⅳ期患者远期生存率高于未行化疗者;Ⅳ期患者乳酸脱氢酶(lactic dehydrogenase,LDH)均值相比Ⅰ~Ⅲ期患者明显升高,且LDH≥281 U/L的患者生存率明显降低;AM患者5年生存率为66%,中位生存期为69.4个月。以性别、年龄、肿瘤部位、病程、卫星病灶、LDH值、红细胞沉降率(erythrocyte sedimentation rate,ESR)、Ki-67标记指数行多因素分析显示,肿瘤部位、病程、LDH、Ki-67标记指数为患者预后的独立危险因素。结论:AM多见于农民及工人,病变多位于足底。规范的外科手术和全身辅助治疗可显著改善患者预后。肿瘤部位、病程、LDH、Ki-67标记指数为影响患者预后的独立危险因素。

Background and purpose: Acral melanoma(AM) is common in China, and the prognosis is poor. The purpose of this study was to analyze the clinical features, treatment methods and therapeutic effects, and to explore the related factors for poor prognosis of AM. Methods: We collected the clinical data of 322 patients with AM from January 2010 to December 2017. The clinical characteristics and prognostic factors of AM were analyzed. Results: AM was more common in peasants(66%) and workers(12%). About 70.5% of the lesions were located in the sole of the foot. The ratio of male and female was 1.3∶1.0, and the median age was 58 years. There was no difference in distribution among various regions of Hunan Province. Local physical stimulation and inflammation were closely related to the occurrence of AM. The prognosis of the patients undergoing standard operation in stage Ⅱ-Ⅲwas significantly better compared with those without surgical treatment. For the plantar melanoma, the necrosis and infection rate of medial plantar artery flap was lower than that of sural neurovascular flap. The time to distant metastasis was longer in postoperative patients receiving systemic adjuvant therapy than in patients without adjuvant therapy. Survival rate of stage Ⅳ patients with chemotherapy was higher than that of patients without chemotherapy. The patients in stage Ⅳ had higher lactic dehydrogenase(LDH)compared with the patients in stage Ⅰ-Ⅲ, while the survival rate of patients with LDH≥281 U/L was lower. The 5-year survival rate of patients with AM was 66%, and the median survival time was 69.4 months. Gender, age, tumor site, duration of the lesion, satellite lesion, LDH, erythrocyte sedimentation rate(ESR) and Ki-67 were used as multivariate analysis. The results showed that tumor site,duration of the lesion, LDH and Ki-67 were independent risk factors for prognosis. Conclusion: AM is more common in peasants and workers, and most of the lesions are located in the sole of the foot. Standard surgical treatment and systemic adjuvant therapy can improve the prognosis of the patients. The tumor site, duration of the lesion, LDH and Ki-67 labelling index are the independent risk factors affecting the prognosis of patients.