肛管直肠恶性黑色素瘤91例外科治疗及预后分析
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摘要
目的探索肛管直肠恶性黑色素瘤(ARMM)的外科治疗方式及影响病人总生存的预后因素。方法回顾分析2003年1月至2018年1月北京大学肿瘤医院胃肠肿瘤中心诊断为ARMM并接受手术治疗的91例病人的临床病理资料。比较不同临床病理因素、手术方式[扩大的局部切除(WLE)与腹会阴联合切除(APR)]对病人总生存的影响。结果在91例ARMM病人中,男性35例(38.5%),女性56例(61.5%),男女比例为1.0∶1.6。接受WLE 12例(13.2%),APR 79例(86.8%)。;术前存在远处转移19例(20.9%),无远处转移72例(79.1%)。病人1、3和5年存活率分别为74%、23%和9%,中位生存期为18.7个月。单因素分析示术前远处转移、肿瘤直径>2 cm、肿瘤侵犯深度>2 mm和淋巴结转移为总生存的影响因素;多因素分析显示术前存在同时性远处转移和淋巴结转移为总生存的独立预后因素。12例接受WLE病人中位生存期为21个月,79例接受APR病人中位生存期为21个月,接受WLE和接受APR病人两组生存期差异无统计学意义(P=0.94)。结论术前存在远处转移、淋巴结转移是ARMM病人总生存的独立预后因素。APR与WLE相比,并不能带来生存的获益。
ObjectiveTo investigate the surgical treatment of anorectal malignant melanoma(ARMM) and the prognostic factors that affect patients' overall survival(OS).MethodsTheclinical and pathological data of 91 patients diagnosed as ARMM, who underwent surgery in the Gastrointestinal Cancer Center of Peking University Cancer Hospital from January 2003 to January 2018 were retrospectively analyzed. The effects of different clinicopathological factors on OS of the patients, and difference surgery, abdominal-perineal resection(APR) and wide local excision(WLE) on patients' survival were compared.ResultsOf the 91 patients with ARMM, 35(38.5%) were male, 56(61.5%) were female, and the ratio of male to female was 1:1.6. 12 patients(13.2%) underwent wide local excision and 79 patients underwent abdominal-perineal resection(86.8%); there were 19 cases(20.9%) diagnosed with distant metastasis and 72 cases(79.1%)without distant metastasis. The of 1-, 3-, and 5-year survival rates of ARMM patients in this cohort were 74%, 23% and9%; and the median survival of the patients was 18.7 months. The univariate analysis of the clinicopathological features of the patients demonstrated that the preoperative distant metastases, tumor diameters(>2 cm), tumor invasion depth(>2 mm) and lymph node metastasis were the prognostic factors of OS; multivariate analysis showed that preoperative distant metastasis and lymph node metastasis were independent factors affecting OS.The median survival of the patients admitted APR and WLE were both 21 months. There was no significant difference in survival between the WLE and APR group(P=0.94).ConclusionPreoperative distant metastasis and lymph node metastasis are independent prognostic factors for overall survival of ARMM patients.Comparing with WLE, APR could not bring survival benefits.
ObjectiveTo investigate the surgical treatment of anorectal malignant melanoma(ARMM) and the prognostic factors that affect patients' overall survival(OS).MethodsTheclinical and pathological data of 91 patients diagnosed as ARMM, who underwent surgery in the Gastrointestinal Cancer Center of Peking University Cancer Hospital from January 2003 to January 2018 were retrospectively analyzed. The effects of different clinicopathological factors on OS of the patients, and difference surgery, abdominal-perineal resection(APR) and wide local excision(WLE) on patients' survival were compared.ResultsOf the 91 patients with ARMM, 35(38.5%) were male, 56(61.5%) were female, and the ratio of male to female was 1:1.6. 12 patients(13.2%) underwent wide local excision and 79 patients underwent abdominal-perineal resection(86.8%); there were 19 cases(20.9%) diagnosed with distant metastasis and 72 cases(79.1%)without distant metastasis. The of 1-, 3-, and 5-year survival rates of ARMM patients in this cohort were 74%, 23% and9%; and the median survival of the patients was 18.7 months. The univariate analysis of the clinicopathological features of the patients demonstrated that the preoperative distant metastases, tumor diameters(>2 cm), tumor invasion depth(>2 mm) and lymph node metastasis were the prognostic factors of OS; multivariate analysis showed that preoperative distant metastasis and lymph node metastasis were independent factors affecting OS.The median survival of the patients admitted APR and WLE were both 21 months. There was no significant difference in survival between the WLE and APR group(P=0.94).ConclusionPreoperative distant metastasis and lymph node metastasis are independent prognostic factors for overall survival of ARMM patients.Comparing with WLE, APR could not bring survival benefits.
引文
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[18]Kanaan Z,Mulhall A,Mahid S,et al.A systematic review of prognosis and therapy of anal malignant melanoma:a plea for more precise reporting of location and thickness[J].Am Surg,2012,78(1):28-35.
[19]Wanebo HJ,Woodruff JM,Farr GH,et al.Anorectal melanoma[J].Cancer,1981,47(7):1891-1900.
[20]Roumen RM,Anorectal melanoma in The Netherlands:a report of 63 patients[J].Eur J Surg Oncol,1996,22(6):598-601.
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[3]Brady,MS,Kavolius JP,Quan SH,Anorectal melanoma.A 64-year experience at Memorial Sloan-Kettering Cancer Center[J].Dis Colon Rectum,1995,38(2):146-151.
[4]Cagir B,Whiteford MH,Topham A,et al.Changing epidemiology of anorectal melanoma[J].Dis Colon Rectum,1999,42(9):1203-1208.
[5]Goldman S,Glimelius B,Pahlman L,et al.Anorectal malignant melanoma in Sweden.Report of 49 patients[J].Dis Colon Rectum,1990,33(10):874-877.
[6]Luna-Perez P,Rodriguez DF,Macouzet JG,et al.Anorectal malignant melanoma[J].Surg Oncol,1996,5(4):165-168.
[7]Iddings DM,Fleisig AJ,Chen SL et al.Practice patterns and outcomes for anorectal melanoma in the USA,reviewingthree decades of treatment:is more extensive surgical resection beneficial in all patients?[J].Ann Surg Oncol,2010,17(1):40-44.
[8]SiegalB,Cohen D,and Jacob ET,Surgical treatment of anorectal melanomas[J].Am J Surg,1983,146(3):336-338.
[9]Carvajal RD,Spencer SA,Lydiatt W,Mucosal melanoma:a clinically and biologicallyunique disease entity[J].J Natl Compr Canc Netw,2012,10(3):345-356.
[10]Droesch JT,Flum DR,Mann GN,et al.Wide local excision or abdominoperineal resection as the initial treatment for anorectal melanoma?[J].Am J Surg,2005,189(4):446-449.
[11]Liu G,Wang Y,Fei F,et al.Clinical characteristics and preliminary morphological observation of 47 cases of primary anorectal malignant melanomas[J].Melanoma Res,2018,28(6):592-599.
[12]Nilsson PJ,Ragnarsson-Olding BK.Importance of clear resection margins in anorectal malignant melanoma[J].Br J Surg2010,97(1):98-103.
[13]Ballantyne AJ.Malignant melanoma of the skin of the head and neck.An analysis of 405 cases[J].Am J Surg,1970,120(4)425-431.
[14]Falch C,Stojadinovic A,Hann-von-Weyhern C,et al.Anorectal malignant melanoma:extensive 45-year review and proposal for anovel staging classification[J].J Am Coll Surg,2013,217(2):324-335.
[15]Ballo MT,Gershenwald JE,Zagars GK,et al.Sphincter-sparing local excision and adjuvant radiation for anal-rectal melanoma[J].J Clin Oncol,2002,20(23):4555-4558.
[16]PerezDR,Trakarnsanga A,Shia J,et al.Locoregional lymphadenectomy in the surgical management of anorectal melanoma[J].Ann Surg Oncol,2013,20(7):2339-2344.
[17]Yeh JJ,Shia J,Hwu WJ,et al.The role of abdominoperineal resection as surgical therapy for anorectalmelanoma[J].Ann Surg,2006,244(6):1012-1017.
[18]Kanaan Z,Mulhall A,Mahid S,et al.A systematic review of prognosis and therapy of anal malignant melanoma:a plea for more precise reporting of location and thickness[J].Am Surg,2012,78(1):28-35.
[19]Wanebo HJ,Woodruff JM,Farr GH,et al.Anorectal melanoma[J].Cancer,1981,47(7):1891-1900.
[20]Roumen RM,Anorectal melanoma in The Netherlands:a report of 63 patients[J].Eur J Surg Oncol,1996,22(6):598-601.