肛管直肠恶性黑色素瘤26例临床特征及预后分析

Clinical Characteristics and Prognosis Analysis of 26 Cases of Anorectal Malignant Melanoma

目的分析并总结肛管直肠恶性黑色素瘤(ARMM)的基本信息、临床症状、病理特征以及手术情况,探讨相关因素对其预后的影响。方法回顾性分析接受手术治疗的26例肛管直肠恶性黑色素瘤患者,通过总结患者的临床特征探讨可能与患者生存期有关联的因素。结果接受腹会阴联合切除术(APR)、局部扩大切除术(WLE)、肛提肌外腹会阴联合切除术(ELAPE)手术患者三组间比较其差异无统计学意义(P=0.257),而肿瘤大小(P=0.027)、肿瘤浸润深度(P=0.001)、肿瘤有无区域性或者局部淋巴结转移(P=0.001)以及肿瘤分期(P=0.000)与生存预后相关。以上因素使用Cox回归多因素分析显示,肿瘤的临床分期是肛管直肠恶性黑色素瘤预后的独立危险因素(RR=9.774,95%CI:2.664~35.865,P=0.001)。结论肿瘤的临床分期是决定肛管直肠恶性黑色素瘤患者生存的关键因素,该病治疗方式以手术治疗为主,三种手术方式APR、WLE、ELAPE对该病预后无明显影响。WLE可作为早期肿瘤患者的首选,APR手术可作为二线手术方案应用于存在局部浸润或者WLE术后复发者,ELAPE手术作为新的手术方式,对于预后的影响仍需探索。

Objective To analyze and summarize the basic information,clinical symptoms,pathological characteristics and operation conditions of anorectal malignant melanoma,and to explore the influence of these factors on prognosis.Methods 26 patients with anorectal malignant melanoma diagnosed and treated by surgery were retrospectively analyzed.The clinical features of the patients were analyzed.Factors associated with the patient's survival were analyzed.Results There was no significant difference between the 3 groups of patients received APR,WLE,and ELAPE(P=0.257).By univariate analysis,the size of the tumor,depth of tumor invasion,presence or absence of regional lymph node metastasis,and tumor stage were associated with prognosis(P=0.027,0.001,0.001,0.000,respectively).The above factors using COX regression multivariate analysis showed that the clinical stage of the tumor was an independent risk factor for the prognosis of anorectal malignant melanoma(RR=9.774,95%CI:2.664~35.865,P=0.001).Conclusion The clinical stage of postoperative tumors was the key factor determining the survival of anorectal malignant melanoma patients.The surgical treatment is the main treatment method.The 3 surgical methods APR,WLE,ELAPE have no significant effect on the prognosis.WLE can be used as the first choice for patients with early anorectal malignant melanoma,and APR surgery can be used as a second-line surgical approach for the patients with local infiltration or recurrence after WLE surgery.ELAPE surgery as a new surgical method,and its impact on the prognosis need further exploration.