Clinical presentation, histology, and prognoses of malignant melanoma in ethnic Chinese: a study of 522 consecutive cases.
Clinical presentation, histology, and prognoses of malignant melanoma in ethnic Chinese: a study of 522 consecutive cases.
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DOI：
10.1186/1471-2407-11-85
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发表时间：
2011-02-25
期刊：
影响因子：
3.8
通讯作者：
Guo J
中科院分区：
文献类型：
--
作者：
Chi Z;Li S;Sheng X;Si L;Cui C;Han M;Guo J
恶性黑色素瘤在亚洲是一种罕见的疾病，对其特征和亚洲患者的临床结局的了解有限。这项观察性研究的目的是确定中国黑色素瘤患者的临床表现和结局。为了进行分析，前瞻性地建立了一个数据库。该数据库的元素包括患者的基本人口统计学数据和先前在文献中报道的统计学数据，以及随访数据，包括治疗后的临床结局。检索2006年以来在我中心就诊的所有病理诊断为恶性黑色素瘤患者的病历并进行回顾性分析。本研究未排除任何患者。采用Kaplan-Meier法和考克斯比例风险模型分别进行生存率和影响生存率因素的多因素分析。共评价了522例连续和非选择病例。肢端雀斑样黑色素瘤（ALM）218例（41.8%），粘膜黑色素瘤（MCM）118例（22.6%），结节性黑色素瘤（NM）103例（19.7%），浅表扩散性黑色素瘤（SSM）33例（6.3%），其余为恶性雀斑样黑色素瘤或无法分类的疾病。临床I期、II期、III期和IV期疾病的患者比例分别为6.1%、55.9%、25.1%和12.8%。在357例皮肤黑色素瘤患者中，234例（65.5%）有溃疡。522例患者的5年总生存率为41.6%，中位生存时间为3.92年（95%CI，3.282 ~ 4.558）。Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者的5年生存率分别为94.1%、44.0%、38.4%和4.6%（P < 0.001）。多因素分析显示，临床分期和溃疡是OS的两个重要影响因素。此外，手术范围和辅助治疗的使用是非转移性疾病患者经明确治疗后DFS的重要影响因素。病理亚型不是预测OS或DFS的重要预后因素。在中国诊断的恶性黑色素瘤患者的预后不理想，大多数患者被诊断为局部晚期疾病（即，II期或以上）。ALM和MCM是两种最常诊断的病理亚型。临床分期和溃疡的存在与OS的临床结局显著相关，而治疗策略（包括手术范围和辅助治疗的使用）是DFS的显著预测因素。
Malignant melanoma is a rare disease in Asia, and knowledge on its characteristics and clinical outcome in Asian patients is limited. The purpose of this observational study was to determine the clinical presentation and outcome of patients with melanoma in China. A database was prospectively established for the purpose of this analysis. The elements of the database included basic demographic data of patients and prognosticators previously reported in literature, as well as follow-up data including clinical outcome after treatment. Medical record of all patients with pathologically diagnosed malignant melanoma consulted in our center since 2006 were retrieved and reviewed. No patient was excluded in this study. Statistical analyses including survival and multivariate analyses of factors associated with survival were respectively performed by Kaplan-Meier method and Cox proportional hazard model. A total of 522 consecutive and nonselected cases were evaluated. There were 218 cases (41.8%) of acral lentiginous melanoma (ALM), 118 (22.6%) of mucosal melanoma (MCM), 103 (19.7%) of nodular melanoma (NM), 33 (6.3%) of superficial spreading melanoma (SSM), and others were Lentigo maligna melanoma or unclassifiable disease. The proportion of patients with clinical stage I, II, III, and IV diseases were 6.1%, 55.9%, 25.1%, and 12.8%, respectively. Among the 357 cases of cutaneous melanoma, 234 patients (65.5%) had ulceration. The 5-year overall survival rate of all 522 patients was 41.6%, and the median survival time was 3.92 years (95% CI, 3.282 to 4.558). Five-year survival rates of patients with stage I, II, III, and IV diseases were 94.1%, 44.0%, 38.4% and 4.6% respectively (P < 0.001). Multivariate analysis revealed that clinical stage and the ulceration were two significant prognosticators for OS. In addition, extent of surgery and use of adjuvant therapy were significant prognosticators for DFS in patients with non-metastatic disease after definitive treatment. Pathological subtype was not a significant prognostic factor to predict wither OS or DFS. Prognoses of patients with malignant melanoma diagnosed in China were suboptimal, and most patients were diagnosed with locally advanced disease (i.e., stage II or above). ALM and MCM are the two most commonly diagnosed pathological subtypes. Clinical staging and presence of ulceration was significantly associated with clinical outcome in terms of OS, while treatment strategy including extent of surgery and use of adjuvant therapy were significant predictors of DFS.
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