Trends in the management of anorectal melanoma: A multi-institutional retrospective study and review of the world literature.
Trends in the management of anorectal melanoma: A multi-institutional retrospective study and review of the world literature.
复制标题
DOI：
10.3748/wjg.v27.i3.267
复制
发表时间：
2021-01-21
影响因子：
4.3
通讯作者：
Asare EA
中科院分区：
文献类型：
--
作者：
Bleicher J;Cohan JN;Huang LC;Peche W;Pickron TB;Scaife CL;Bowles TL;Hyngstrom JR;Asare EA
肛门直肠黑色素瘤（ARM）是一种罕见的疾病，预后差。关于最佳治疗方法的证据有限，手术治疗方法也各不相同。我们假设，在过去的几十年里，腹会阴切除术作为ARM的主要治疗方法的频率有所下降。更新我们对ARM患者预后的理解，并分析世界范围内的管理趋势。这是一项多机构的回顾性研究，研究对象是在7家医院接受ARM治疗的患者。医院包括大型学术三级保健中心和较小的综合性社区医院。使用前瞻性维持的机构肿瘤登记处，我们确定了2000年1月至2019年5月期间诊断为ARM的24例患者。我们分析了影响复发和生存的因素。然后我们使用Cox回归来测量总生存期（OS）和黑色素瘤特异性生存期。我们还进行了文献回顾，以评估手术治疗和结果的趋势。在24例确诊为ARM的患者中，12例（50.0%）诊断为局部疾病，8例（33.3%）为区域性疾病，4例（16.7%）为远处疾病。中位复发时间为10.4个月[四分位数范围（IQR） 7.5-17.2]，只有2例（9.3%）患者在手术切除后没有复发。中位OS为18.8个月（IQR为13.5-33.9）。1例患者在诊断后21.4个月仍未复发；没有其他患者存活5年。腹会阴切除（APR）与广泛切除（WE）的初步手术处理没有导致OS的差异[风险比= 1.4 (95%CI: 0.3-6.8)]。文献回顾揭示了ARM手术治疗的地理差异，随着时间的推移，WE在美国和欧洲的使用越来越多，而APR在亚洲和印度的使用越来越频繁。随着时间的推移，生存率没有显著提高。ARM的管理存在很大差异，无论采用何种方法，生存结果仍然很差。手术治疗应以减少发病率为目标。
Anorectal melanoma (ARM) is a rare disease with a poor prognosis. Evidence on optimal treatment is limited and surgical management varies widely. We hypothesized that the frequency of abdominoperineal resection used as primary treatment of ARM has decreased over the past several decades. To update our understanding of outcomes for patients with ARM and analyze management trends around the world. This is a multi-institutional, retrospective study of patients treated for ARM at 7 hospitals. Hospitals included both large, academic, tertiary care centers and smaller, general community hospitals. Using prospectively maintained institutional tumor registries, we identified 24 patients diagnosed with ARM between January 2000 and May 2019. We analyzed factors prognostic for recurrence and survival. We then used Cox regression to measure overall survival (OS) and melanoma-specific survival. We also performed a literature review to assess trends in surgical management and outcomes. Of the 24 patients diagnosed with ARM, 12 (50.0%) had local, 8 (33.3%) regional, and 4 (16.7%) distant disease at diagnosis. Median time to recurrence was 10.4 mo [interquartile range (IQR) 7.5-17.2] with only 2 patients (9.3%) not developing recurrence following surgical resection. Median OS was 18.8 mo (IQR 13.5-33.9). One patient is still alive without recurrence at 21.4 mo from diagnosis; no other patient survived 5 years. Primary surgical management with abdominoperineal resection (APR) vs wide excision (WE) did not lead to differences in OS [hazard ratio = 1.4 (95%CI: 0.3-6.8)]. Review of the literature revealed geographic differences in surgical management of ARM, with increased use of WE in the United States and Europe over time and more frequent use of APR in Asia and India. There was no significant improvement in survival over time. There is wide variation in the management of ARM and survival outcomes remain poor regardless of approach. Surgical management should aim to minimize morbidity.
登录
查看更多内容
影响因子：
0.8
作者：
Khan M;Bucher N;Elhassan A;Barbaryan A;Ali AM;Hussain N;Mirrakhimov AE
通讯作者：
Mirrakhimov AE
DOI：
10.1158/1078-0432.ccr-17-2386
发表时间：
2018-10-15
期刊：
Clinical cancer research : an official journal of the American Association for Cancer Research
影响因子：
--
作者：
Joseph RW;Elassaiss-Schaap J;Kefford R;Hwu WJ;Wolchok JD;Joshua AM;Ribas A;Hodi FS;Hamid O;Robert C;Daud A;Dronca R;Hersey P;Weber JS;Patnaik A;de Alwis DP;Perrone A;Zhang J;Kang SP;Ebbinghaus S;Anderson KM;Gangadhar TC
通讯作者：
Gangadhar TC
影响因子：
6.2
作者：
Kelly, Patrick;Zagars, Gunar K.;Guadagnolo, B. Ashleigh
通讯作者：
Guadagnolo, B. Ashleigh
影响因子：
1.1
作者：
Cai, Yan-Tao;Cao, Li-Chen;Guo, Shan-Yu
通讯作者：
Guo, Shan-Yu
影响因子：
4.5
作者：
Dodds, Tristan J.;Wilmott, James S.;Scolyer, Richard A.
通讯作者：
Scolyer, Richard A.