87例肛管直肠恶性黑色素瘤临床分析

Clinicopathological features of 87 cases of anorectal malignant melanoma

目的分析肛管直肠恶性黑色素瘤(ARMM)患者临床病理特征并进一步比较不同TNM分期及非手术与手术治疗患者的预后差异,进而探讨ARMM的有效治疗方案。方法回顾性分析2006~2017年就诊于山西省肿瘤医院结直肠外科的87例ARMM患者的病历资料,包括性别、年龄、肿瘤分期、免疫组化标志物:AE1/AE3、HMB45、S-100及Vimentin。探讨影响ARMM患者预后的因素,并进一步探究Ⅰ+Ⅱ期、Ⅲ期、Ⅳ期患者进行手术治疗及非手术治疗预后的关系。结果87例患者年龄、性别、AE1/AE3、HMB45及S-100等因素对预后影响无统计学意义,Ⅰ+Ⅱ期患者预后好于Ⅳ期患者,差异有统计学意义(P<0.05)。52例接受手术治疗,35例接受非手术治疗(包括放弃治疗),手术组预后要明显好于非手术组,差异具有统计学意义(χ^(2)=13.2,P<0.05)。其中Ⅰ+Ⅱ、Ⅲ期患者,接受手术治疗预后要明显好于非手术治疗,差异具有统计学意义,但不同手术方式对预后影响无统计学意义(P>0.05);Ⅳ期患者,手术治疗或非手术治疗对预后影响无统计学意义(P>0.05),但Ⅳ期手术患者,局部切除预后好于腹会阴联合切除(APR),差异有统计学意义(P<0.05)。结论ARMM预后差,Ⅰ、Ⅱ、Ⅲ期患者,建议行手术治疗,包括局部切除及APR手术切除,Ⅳ期患者,首选肿瘤局部切除。

Objective By collect the clinicopathological characteristics of patients with anorectal malignant melanoma(ARMM),and analysis the prognostic differences between different TNM stages and non-surgical&surgical treatment groups.To find the effective treatment for ARMM.Methods We retrospective analysis of 87 ARMM patients clinical information,they were treated in the Colorectal Surgery Department of Shanxi Cancer Hospital from 2006 to 2017.The clinical features including gender,age,tumor stage,and immunohistochemical markers:AE1/AE3,HMB45,S-100 and Vimentin.Aim to find the factors associatied with the prognosis of ARMM,and to compare the difference of surgical treatment and non-surgical treatment group among stageⅠ+Ⅱ,stageⅢ,and stageⅣ.Results Our results showed that age,gender,AE1/AE3,HMB45,S-100 had no significant effect on ARMM patients prognosis.However,patients with stageⅠ+Ⅱhad better prognosis than patients with stageⅣ,and the result had statistical significance(P<0.05).In our results,fifty-two patients received surgical treatment,and 35 received non-surgical treatment(including giving up treatment).The prognosis of the surgical group was significantly better than the non-surgical group(χ^(2)=13.2,P<0.05).For patients with stageⅠ+ⅡandⅢ,the prognosis of surgical treatment was significantly better than non-surgical treatment(P<0.05),but the effect of surgical methods on prognosis was no difference(P>0.05).In patients with stageⅣ,the prognosis of local resection was better than abdominoperineal resection(APR)(P<0.05).Conclusion ARMM has a poor prognosis.Compared with non-surgical treatment,surgical treatment may be a better treatment way to improve the survival rate of patients.For stage I,II,and III patients,local excision is the preferred surgical approach.