170例下肢肢端皮肤恶性黑色素瘤的外科治疗及预后分析

Surgical treatment and prognostic analysis of 170 cases of malignant melanoma of the acral skin of lower extremities

目的探讨肢端恶性黑色素瘤(Acral melanoma,AM)的临床特征、手术方法及疗效,探讨预后的相关因素。方法回顾性收集2006年1月~2016年12月收治的170例可手术切除AM患者的临床资料,分析临床特征、治疗方法及预后情况。结果170例AM患者获得随访,随访时间12~96个月,男女比例1.3∶1.0,发病年龄9~83岁,中位年龄58岁,79.4%的病灶位于足底,原发灶Breslow厚度>4 mm占54.7%,70.6%肿瘤存在破溃,Ⅱb~Ⅲc期患者占85.9%。170例患者均接受了原发灶的扩大切除及修复,86例同期行区域淋巴结清扫手术。患者的1、2和5年生存率分别为80.6%(137/170)、57.6%(98/170)及31.2%(53/170)。多元Cox逐步回归结果显示,病理分期、肿瘤溃疡、肿瘤厚度、淋巴结转移为患者预后的独立危险因素。结论肢端恶性黑色素瘤局部侵袭性强,预后较差,治疗应以外科手术为基础的综合治疗。患者预后与肿瘤溃疡、肿瘤厚度、淋巴结转移等因素有关。

Objective To study explore the clinical features,surgical methods and efficacy of acral melanoma(AM),and to explore the prognostic factors.Methods A total of 170 patients with surgically resected AM from January 2006 to December 2016 were retrospectively collected,and the clinical characteristics,treatment methods and prognosis were analyzed.Results A total of 170 patients with AM were followed up for 12 to 96 months.The male to female ratio was 1.3:1.0,the age of onset was 9-83 years old,with the median age of 58 years old.79.4%of the lesions were located on the sole of the foot.The Breslow thickness of the primary lesion>4 mm accounted for 54.7%.70.6%of the tumors had ulceration,and patients with stageⅡb toⅢc accounted for 85.9%.All 170 patients underwent enlarged resection and repair of the primary tumor,and 86 patients underwent regional lymph node dissection at the same time.The 1,2 and 5-year survival rates of the patients were 80.6%(137/170),57.6%(98/170)and 31.2%(53/170),respectively.Multivariate Cox stepwise regression results showed that tumor stage,tumor rupture,tumor thickness,and lymph node metastasis were independent risk factors for patient prognosis.Conclusion Acral malignant melanoma has strong local invasiveness and poor prognosis.comprehensive treatment based on surgery should be given.The prognosis of patients is related to factors such as tumor ulcers,tumor thickness,and lymph node metastasis.