外伤相关黑素瘤87例临床病理特点与预后分析

Clinicopathological characteristics and prognosis of 87 cases of trauma-related melanomas

目的分析外伤相关黑素瘤的临床病理特点及其与患者预后间的关系。方法回顾性分析2009—2020年第四军医大学西京皮肤医院87例外伤相关黑素瘤的临床病理特点,通过Mann-Whitney检验分析不同年龄、性别患者间肿瘤Breslow厚度的差异;通过Spearman秩相关分析外伤至发现皮疹的时间与Breslow厚度之间的相关性;采用Kaplan-Meier生存分析和Log-Rank检验法分析黑素瘤临床病理特点与患者预后间的关系;采用Cox回归模型分析影响外伤相关黑素瘤患者生存时间的危险因素。结果87例外伤相关黑素瘤患者中,男47例(54.02%)、女40例(45.98%),50例(57.47%)由锐伤引起,37例(42.53%)由钝伤引起。31例(35.63%)原发皮损位于手部,48例(55.17%)位于足部。>55岁组患者原发肿瘤Breslow厚度显著高于≤55岁组(U=623.500,P=0.010),而不同性别患者间差异无统计学意义(P=0.138)。外伤至发现皮疹的时间与肿瘤Breslow厚度呈负相关(r=-0.203,P=0.037)。患者年龄、肿瘤Breslow厚度、Ki67增殖指数和肿瘤遗传背景均显著影响外伤相关黑素瘤患者的生存时间(P<0.05或<0.01);性别、外伤类型、瘤团有无溃疡未明显影响患者的生存时间(均P>0.05)。Cox回归模型分析显示,肿瘤Ki67增殖指数及Breslow厚度是影响外伤相关黑素瘤患者预后的独立危险因素[RR值(95%CI)分别为1.946(1.234,4.217)、1.839(1.014,3.332),P值分别为0.039、0.045]。结论外伤相关黑素瘤的Breslow厚度与患者年龄、外伤至发现皮疹的时间相关;年龄、肿瘤Breslow厚度、Ki67增殖指数和肿瘤遗传背景均影响黑素瘤患者的生存时间,且Ki67增殖指数和肿瘤Breslow厚度是影响预后的独立危险因素。

Objective To analyze clinicopathological characteristics of trauma-related melanoma and their relationship with the prognosis of patients.Methods Clinical data were collected from 87 cases of trauma-related melanomas in Department of Dermatology,Xijing Hospital,the Fourth Military Medical University from 2009 to 2020,and their clinicopathological characteristics were retrospectively analyzed.Mann-Whitney test was used to analyze the difference in Breslow thickness of tumors between patients of different ages or genders;Spearman rank correlation analysis was used to analyze the correlation between the time from trauma to the notice of melanoma and Breslow thickness,Kaplan-Meier survival analysis and Log-Rank test were employed to analyze the relationship between clinicopathological characteristics of melanoma and the prognosis of patients;Cox regression model was used to analyze risk factors for survival duration of patients with trauma-related melanoma.Results Among the 87 patients with trauma-related melanoma,47(54.02%)were males and 40(45.98%)were females.Among them,melanoma occurred in 50(57.47%)cases after sharp injuries,and in 37(42.53%)after blunt injuries.In addition,31(35.63%)cases presented with primary lesions on the hands,and 48(55.17%)on the feet.The Breslow thickness of the primary tumors was significantly higher in the group aged>55 years than in the group aged≤55 years(U=623.500,P=0.010),but there was no significant difference between patients of different genders(P=0.138).The time from trauma to the notice of melanoma was negatively correlated with the Breslow thickness of tumors(r=-0.203,P=0.037).The age of patients,Breslow thickness of tumors,Ki67 proliferation index and genetic background of tumor significantly affect the survival duration of patients with trauma-related melanoma(P=0.011,0.031,0.002 and 0.031,respectively);the gender,type of trauma and ulceration of tumor mass did not significantly affect the survival duration of patients(P=0.618,0.114 and 0.379,respectively).Cox regression model analysis showed that the Ki67 proliferation index and Breslow thickness were independent risk factors affecting the prognosis of trauma-related melanoma(risk ratio[RR]and 95%confidence interval[CI]were 1.946(1.234,4.217)and 1.839(1.014,3.332),P=0.039 and 0.045,respectively).Conclusion The Breslow thickness of trauma-related melanoma is related to the age of patients and time from trauma to the notice of melanoma;the age,Breslow thickness of tumors,Ki67 proliferation index and genetic background of tumor all affect the survival duration of patients with melanoma,and Ki67 proliferation index and Breslow thickness are independent risk factors affecting prognosis.