口腔黏膜恶性黑色素瘤肺转移特征及预后分析

Characteristics and prognostic analysis of oral mucosal melanoma with lung metastasis

背景与目的:口腔黏膜恶性黑色素瘤(oral mucosal melanoma,OMM)是一类高度恶性的实体肿瘤,其远处转移率约40%,其中肺是最常见的远处转移部位;本研究旨在探讨OMM肺转移特征及预后影响因素,以期找到肺转移OMM最佳的治疗模式。方法:回顾性分析2017年1月—2021年1月于上海交通大学医学院附属第九人民医院确诊的肺转移OMM病例,总结胸部计算机体层成像(computed tomography,CT)的影像学特征,采用Kaplan-Meier方法进行生存分析。结果:88%的OMM患者在术后2年内确诊肺转移,其中第1年22例(52%),第2年15例(36%);71%的患者胸部CT表现为大小不一、多发、圆形或椭圆形结节,寡转移少见(10%);不按期随访(P=0.009)、合并局部复发(P=0.037)、合并胸腔积液(P=0.042)以及未行免疫治疗(P=0.000)会显著缩短患者的生存期。合并复发的患者对程序性死亡[蛋白]-1(programmed death-1,PD-1)免疫治疗的应答显著降低(P=0.009),PD-1单药治疗的中位生存期只有10个月,联合抗血管靶向药物后中位生存期可延长至19个月(P=0.019)。结论:OMM易发生肺转移,即使小于1 cm的微小结节也可以发生转移灶。OMM转移最常发生在术后1~2年内,定期随访一定程度上能及早发现转移病灶从而延长患者的生存期。既复发又转移的OMM患者接受单纯免疫治疗往往效果欠佳,联合抗血管靶向治疗也许会有更好的治疗结局。

Background and purpose:Oral mucosal malignant melanoma(OMM)is a highly malignant solid tumor with a distant metastasis rate of about 40%.The lung is the most common metastatic site.This study aimed to investigate the characteristics and prognostic analysis of OMM with lung metastasis,in order to find the best treatment mode for OMM with lung metastasis.Methods:The data of the patients with lung metastasis diagnosed in the Ninth People’s Hospital Affiliated to the Medical College of Shanghai Jiao Tong University from January 2017 to January 2021 were retrospectively analyzed.The imaging characteristics of chest computed tomography(CT)were summarized,and Kaplan-Meier method was used for survival analysis.Results:In this study,88%of patients with OMM were diagnosed with lung metastasis within 2 years after operation,including 22 cases(52%)in the first year and 15 cases(36%)in the second year;71%of patients showed multiple,round or oval nodules of different sizes on chest CT,and few single metastases(10%).Non-scheduled follow-up(P=0.009),concurrent local recurrence(P=0.037),concurrent pleural effusion(P=0.042)and no immunotherapy(P=0.000)could significantly reduce the survival time of patients.The response of patients with relapse to programmed death-1(PD-1)immunotherapy was significantly reduced(P=0.009),and the median overall survival(OS)of PD-1 single drug was only 10 months.After combination therapy with PD-1 and anti-vascular targeted drugs,the median OS could be increased to about 19 months(P=0.019).Conclusion:OMM is prone to lung metastasis,and even tiny nodules less than 1cm can be metastatic foci.The metastasis of OMM most often occurs within 1-2 years after operation.Regular follow-up can detect early metastasis and significantly prolong the survival.The efficacy of immunotherapy alone for recurrent and metastatic OMM is also poor,and immunotherapy combined with anti-vascular targeted therapy is required.