CAJ | 학술논문

目的探讨鼻腔鼻窦黏膜恶性黑色素瘤的进展规律及疗效.方法回顾分析2000-2012年间94例鼻腔鼻窦黑色素瘤资料.男50例、女44例,发病年龄26～ 85岁(中位数60岁).原发鼻腔86例、上颌窦7例、鼻咽部1例.颈部淋巴结转移10例(7例疗前、2例疗中、1例疗后),无远处转移.采用手术±放疗方法.采用Kaplan-Meier法计算生存率并Logrank法单因素预后分析,Cox模型多因素预后分析.结果全组1、3、5年样本数量分别为80、54、50例,1、3、5年疾病相关生存率分别为71％、33％、22％.单因素分析发现影响预后因素为年龄＞55岁(P =0.034)、累及后鼻孔(P=0.011)、累及上颌窦(P =0.009)、累及硬腭(P =0.003)、颈部淋巴结转移(P=0.001)、治疗方式(P=0.038).多因素分析发现影响预后因素为累及后鼻孔(P =0.027)、累及眼眶(P =0.005)、累及硬腭(P=0.003).结论鼻腔鼻窦黏膜恶性黑色素瘤的远处转移和局部复发率较高,需多学科多手段联合治疗;颈部淋巴结转移率较低;临床分期的合理性有待进一步研究.
목적 탐토비강비두점막악성흑색소류적진전규률급료효.방법 회고분석2000-2012년간94례비강비두흑색소류자료.남50례、녀44례,발병년령26～ 85세(중위수60세).원발비강86례、상합두7례、비인부1례.경부림파결전이10례(7례료전、2례료중、1례료후),무원처전이.채용수술±방료방법.채용Kaplan-Meier법계산생존솔병Logrank법단인소예후분석,Cox모형다인소예후분석.결과 전조1、3、5년양본수량분별위80、54、50례,1、3、5년질병상관생존솔분별위71％、33％、22％.단인소분석발현영향예후인소위년령＞55세(P =0.034)、루급후비공(P=0.011)、루급상합두(P =0.009)、루급경악(P =0.003)、경부림파결전이(P=0.001)、치료방식(P=0.038).다인소분석발현영향예후인소위루급후비공(P =0.027)、루급안광(P =0.005)、루급경악(P=0.003).결론 비강비두점막악성흑색소류적원처전이화국부복발솔교고,수다학과다수단연합치료;경부림파결전이솔교저;림상분기적합이성유대진일보연구.
Objective To investigate the clinical features and survival status of mucosal melanoma of the nasal cavity and paranasal sinuses and to analyze the prognostic factors.Methods A retrospective analysis was performed on the clinical data of 94 patients with mucosal melanoma of the nasal cavity and paranasal sinuses treated from January 2000 to December 2012.Of the 94 patients,50 were male,and 44 were female.The median age of onset was 60 years (range,26-85 years).The primary sites were nasal cavity (86 patients),maxillary sinus (7 patients),and nasopharynx (1 patient).Cervical lymph node metastasis was observed in 10 patients (7 patients before treatment,2 patients during treatment,and 1 patient after treatment).No patient had distant metastasis.Patients were treated with surgery ± radiotherapy.The Kaplan-Meier method was used to calculate survival rates,and the logrank test was used for univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis.Results The 1-,3-,and 5-year sample sizes were 80,54,and 50,respectively.The 1-,3-,and 5-year disease-related survival rates were 71％,33％,and 22％,respectively.Univariate analysis showed that the prognostic factors were age over 55 years (P =0.034),involvement of the posterior naris (P =0.011),involvement of the maxillary sinus (P =0.009),involvement of the hard palate (P =0.003),cervical lymph node metastasis (P =0.001),and therapeutic method (P =0.038).Multivariate analysis showed that the prognostic factors were involvement of the posterior naris (P =0.027),involvement of the orbit (P =0.005),and involvement of the hard palate (P =0.003).Conclusions The distant metastasis and local recurrence rates are high among patients with mucosal melanoma of the nasal cavity and paranasal sinuses,so combination therapy is imperative.Cervical lymph node metastasis rate is low.Rational clinical staging needs to be further explored.