四例原发性肺恶性黑色素瘤患者的临床特征并文献复习

Clinical features of 4 cases of primary pulmonary malignant melanoma and literature review

目的探讨及分析原发性肺恶性黑色素瘤(primary malignant melanoma of the lung,PMML)的临床特征。方法回顾性分析4例PMML患者的病历资料、影像学检查、病理结果、治疗和预后等,并结合96例文献报道个案病例,共100例PMML患者,分析周围型和中央型PMML的临床特征。结果100例PMML患者中,男60例(60.0%),女40例(40.0%),平均年龄(55.9±10.3)岁。常见的临床症状有咳嗽(56.0%)、胸闷或胸痛(18.0%)、咯血(16.0%)、呼吸困难(11.0%)。患者首次诊断评估肿瘤临床分期为Ⅰ期有7例(7.0%),Ⅱ期有24例(24.0%),Ⅲ期有13例(13.0%),Ⅳ期有39例(39.0%),17例(17.0%)未提及明确肿瘤分期。有30例(30.0%)行抗肿瘤综合治疗,53例(53.0%)行手术切除治疗,其中有17例(17.0%)行术后辅助综合治疗。PMML患者的总体中位生存时间为8.0(2.0~14.4)个月,且Ⅳ期PMML患者的中位生存时间为5.0(3.1~6.9)个月,明显低于Ⅱ期24.0(6.0~32.0)个月(P<0.05)和Ⅲ期患者15.0(0.6~29.4)个月(P<0.05)。进一步分析,不同的治疗方案对于Ⅳ期PMML患者的中位生存时间无明显影响(P>0.05)。结论PMML恶性程度高,无特异性临床症状,主要依靠病理确诊,手术切除、术后辅助放化疗或免疫治疗是目前主要的治疗方式,但其总体预后较差。

Objective To investigate and analyze the clinical features of primary pulmonary malignant melanoma.Methods The medical records,imaging examinations,pathological results,treatment and prognosis of four primary pulmonary malignant melanoma(PMML)patients were retrospectively collected.In combination with 96 cases reported in the literature,a total of 100 patients with PMML were analyzed.Results Among the 100 PMML patients,there were 60 males(60.0%)and 40 females(40.0%),with an average age of 56.9±10.3 years.Common clinical symptoms were cough(60.0%),chest tightness or pain(18.0%),hemoptysis(16.0%),and dyspnea(11.0%).Distant metastasis was found in 30 cases(30.0%)at the time of consultation.The clinical stage of the first diagnosis and evaluation of the patients was stageⅠin 7 cases(7.0%),stageⅡin 24 cases(24.0%),stageⅢin 13 cases(13.0%),stageⅣin 39 cases(39.0%),and 17 cases(17.0%)did not mention a clear tumor stage.Thirty patients(30.0%)received comprehensive anti-tumor therapy,53 patients(53.0%)received surgical resection,and 17 patients among them(17.0%)received postoperative adjuvant comprehensive therapy.The overall median survival time of PMML patients was 8.0(2.0-14.4)months.The median survival time of stageⅣPMML patients was 5.0(3.1-6.9)months,which was significantly lower than 24.0(6.0-32.0)months of stageⅡpatients(P<0.05)and 15.0(0.6-29.4)months of stageⅢpatients(P<0.05).Further analysis showed that different treatment regimens had no significant effect on the median survival time of patients with stageⅣPMML(P>0.05).Conclusions PMML has a high degree of malignancy and no specific clinical symptoms.It is mainly diagnosed by pathology.Surgical resection,postoperative adjuvant chemoradiotherapy or immunotherapy are the main treatment methods,but its overall prognosis is poor.