46例原发性女性生殖道恶性黑色素瘤的预后分析及PD-1单抗疗效初步评估

Prognostic analysis of 46 cases of primary malignant melanoma of female genital tract and preliminary evaluation of the efficacy of PD-1 mab

目的:分析生殖道恶性黑色素瘤患者的预后相关因素及PD-1单抗疗效评估。方法:回顾分析2005年10月~2022年7月云南省肿瘤医院收治的46例女性生殖道恶性黑色素瘤患者的临床特征及生存状况。结果:外阴黑色素瘤的5年生存率为57.1%,Ⅰ期、Ⅱ期患者的总生存期(OS)明显长于Ⅲ/Ⅳ期(78.5个月、未达到vs 15.0个月,P=0.003),术后使用辅助治疗的中位无复发生存时间(RFS)显著长于未辅助治疗组(50.9个月vs 5.3个月,P=0.003);阴道宫颈黑色素瘤的3年生存率为38.9%,阴道黑色素瘤局切组中位RFS及OS均低于根治组(RFS:4.5个月vs 11.0个月,P=0.073;OS:23.6个月vs 29.5个月,P=0.695);晚期女性生殖道黑色素瘤免疫治疗组中位RFS较未免疫治疗组延长(8.2个月vs 3.5个月,P=0.063),免疫治疗组中位OS未达到,未免疫治疗组中位OS为8.5个月,差异无统计学意义(P=0.320)。结论:外阴黑色素瘤预后最好,分期越晚,预后越差;Ⅰ、Ⅱ期外阴黑色素瘤术后加用辅助治疗可延长患者的无瘤生存期;肿瘤局限于阴道壁的阴道黑色素瘤,根治性手术治疗较局部肿瘤切除治疗获益更大;晚期女性生殖道黑色素瘤免疫治疗相较于其他治疗获益更大。

Objective:To explore the prognosis of patients with malignant melanoma of the female reproductive tract and the evaluation of the efficacy of PD-1 monoclonal antibody.Methods:The clinical characteristics and survival status of 46 patients with malignant melanoma of the female reproductive tract treated in Yunnan Cancer Hospital from October 2005 to July 2022 were collected retrospectively.Result:The 5-year survival rate of vulvar melanoma was 57.1%.The OS of patients with stageⅠandⅡwas significantly longer than that of stageⅢ/Ⅳ(78.5 months vs unreached vs 15.0 months,P=0.003).The median RFS of postoperative adjuvant therapy was significantly longer than that of the non-adjuvant therapy group(50.9 months vs 5.3 months,P=0.003).The 3-year survival rate of vaginal cervical melanoma was 38.9%.The median RFS and OS in the local resection group were lower than those in the radical group(RFS:4.5 months vs 11.0 months,P=0.073;OS:23.6 months vs 29.5 months,P=0.695).The median RFS of advanced female genital melanoma in the immunotherapy group was longer than that in the non-immunotherapy group(8.2months vs 3.5 months,P=0.063).The median OS in the immunotherapy group was not reached,and the median OS in the non-immunotherapy group was 8.5 months(P=0.320).Conclusions:The prognosis of vulvar melanoma is the best,and the prognosis becomes worse with the increase of stage.Postoperative adjuvant therapy for stageⅠandⅡvulvar melanoma can prolong the tumor-free survival time of patients.Vaginal melanoma is confined to the vaginal wall,radical surgery benefits more than local tumor resection,and immunotherapy for advanced female genital melanoma benefits more than other treatments.