原发鼻腔黑色素瘤24例临床分析

Clinical analysis of 24 patients with melanoma in the nasal cavity

目的 评价鼻腔黑色素瘤的治疗方法及疗效。方法 对 2 4例鼻腔黑色素瘤进行回顾性分析。临床分期中Ⅰ期 6例 ,Ⅱ期 6例 ,Ⅲ期 8例 ,Ⅳ期 4例。病理分型中巨细胞型 12例 ,小细胞型7例 ,上皮样细胞型 3例 ,梭形细胞型 2例。治疗方法中单纯手术治疗 12例 ,单纯放射治疗 2例 ,手术加放射治疗 7例 ,手术加化疗 2例 ,化疗加生物治疗 1例。生存分析采用Kaplan Meier法 ,组间比较采用Logrank检验 ,率的比较采用 χ2 检验。结果 6例首诊误诊 ,后经免疫组织化学确诊。治疗后总的3、5年生存率分别为 4 0 .9%、2 2 .7%。单纯手术组 5年生存率为 33.3% ,手术加放射治疗组 5年生存率为 16 .7% ,两者相比差异无显著性意义 (P =0 .70 8) ,两组局部复发率差异也无显著性意义 (P =0 .35 0 )。 5年局部复发率为 4 0 % ,5年远地转移率为 16 %。结论 免疫组织化学对黑色素瘤诊断和鉴别诊断有重要价值 ,手术不彻底是疗效不满意的主要原因 ,辅助放射治疗可能有助于提高局部控制率。

ObjectiveTo evaluate the clinical effect and treatment for malignant melanoma in the nasal cavity. MethodsTwenty-four patients suffering from malignant melanoma in the nasal cavity were retrospectively studied. There were 6 patients with stage I,6 stage Ⅱ,8 stage Ⅲ and 4 stage Ⅳ lesions. All were confirmed by histology: 12 giant-cell type,7 small-cell type,3 epithelial-cell type and 2 fusiform-cell type. The problem of misdiagnosis of 6 patients was finally solved by immunohistochemical methods. Twelve patients received surgery alone,2 radiotherapy alone,7 surgery plus radiotherapy,2 surgery plus chemotherapy and 1 chemotherapy plus biotherapy. Survival analysis was performed by Kaplan-Meier estimates and the comparisons between groups were performed by Log-rank test. Chi square test was used in the comparison of rates. ResultsThe overall 3-year and 5-year survival rates were 40.9% and 22.7%. The 5-year survival rates for patients who received surgery alone and those who received surgery plus radiotherapy were 33.3% and 16.7% respectively,with the difference insignificant (P=0.708). There was no significant difference in recurrence rate between the two groups (P= 0.350 ). The 5-year local recurrence and distant metastasis rates were 40% and 16%. ConclusionsImmunohistochemistry is important in the diagnosis and differential diagnosis of malignant melanoma. Incomplete surgery is the main reason for unsatisfactory effect. Adjuvant radiotherapy may improve the local control.