肿瘤研究与临床
腫瘤研究與臨床
종류연구여림상
CANCER RESEARCH AND CLINIC
2014年
6期
389-393
,共5页
杨雯靖%李耀平%侯生槐%江波%刘海义%白文启%毛光华
楊雯靖%李耀平%侯生槐%江波%劉海義%白文啟%毛光華
양문정%리요평%후생괴%강파%류해의%백문계%모광화
黑色素瘤%肛管%直肠%外科手术%综合治疗
黑色素瘤%肛管%直腸%外科手術%綜閤治療
흑색소류%항관%직장%외과수술%종합치료
Melanoma%Anal canal%Rectum%Surgical procedures,operative%Multidisciplinary therapy
目的 通过对肛管直肠恶性黑色素瘤患者的临床病理特征、诊断治疗及生存预后进行分析,规范手术方式,探讨综合治疗模式.方法 回顾性分析38例经手术治疗的肛管直肠恶性黑色素瘤患者的临床病理资料,分析其与预后的相关性.结果 本组38例患者中,男10例,女28例,平均年龄58.7岁(28～75岁),行腹会阴联合切除术28例,局部扩大切除术10例.1、3、5年无病生存率分别为64.9％、18.5％、5.7％,1、3、5年总生存率分别85.8％、24.1％、6.4％.肿瘤厚度≥1.51 mm、肿瘤直径≥3 cm与淋巴结转移相关(x2值分别为13.093、4.449;P值分别为0.011、0.020),且肿瘤厚度亦与远处转移相关(x2=11.965,P=0.018).单因素分析显示,术后辅助治疗与无病生存相关(x2=7.441,P=0.006);肿瘤厚度、淋巴结转移、临床分期与总生存相关(x2值分别为16.741、16.474、16.775;P值分别为0.002、0.000、0.000).多因素分析显示,术后辅助治疗为无病生存的独立危险因素(95％CI 1.420～17.621,P=0.012);肿瘤厚度、淋巴结转移为总生存的独立危险因素(95％ CI 0.250～0.949,P=0.035;95％ CI 1.033～2.573,P=0.036).结论 早期诊断、合理选择手术方式、重视免疫治疗的多学科协作诊疗是提高肛管直肠恶性黑色素瘤患者生存质量、延长生存期的关键.
目的 通過對肛管直腸噁性黑色素瘤患者的臨床病理特徵、診斷治療及生存預後進行分析,規範手術方式,探討綜閤治療模式.方法 迴顧性分析38例經手術治療的肛管直腸噁性黑色素瘤患者的臨床病理資料,分析其與預後的相關性.結果 本組38例患者中,男10例,女28例,平均年齡58.7歲(28～75歲),行腹會陰聯閤切除術28例,跼部擴大切除術10例.1、3、5年無病生存率分彆為64.9％、18.5％、5.7％,1、3、5年總生存率分彆85.8％、24.1％、6.4％.腫瘤厚度≥1.51 mm、腫瘤直徑≥3 cm與淋巴結轉移相關(x2值分彆為13.093、4.449;P值分彆為0.011、0.020),且腫瘤厚度亦與遠處轉移相關(x2=11.965,P=0.018).單因素分析顯示,術後輔助治療與無病生存相關(x2=7.441,P=0.006);腫瘤厚度、淋巴結轉移、臨床分期與總生存相關(x2值分彆為16.741、16.474、16.775;P值分彆為0.002、0.000、0.000).多因素分析顯示,術後輔助治療為無病生存的獨立危險因素(95％CI 1.420～17.621,P=0.012);腫瘤厚度、淋巴結轉移為總生存的獨立危險因素(95％ CI 0.250～0.949,P=0.035;95％ CI 1.033～2.573,P=0.036).結論 早期診斷、閤理選擇手術方式、重視免疫治療的多學科協作診療是提高肛管直腸噁性黑色素瘤患者生存質量、延長生存期的關鍵.
목적 통과대항관직장악성흑색소류환자적림상병리특정、진단치료급생존예후진행분석,규범수술방식,탐토종합치료모식.방법 회고성분석38례경수술치료적항관직장악성흑색소류환자적림상병리자료,분석기여예후적상관성.결과 본조38례환자중,남10례,녀28례,평균년령58.7세(28～75세),행복회음연합절제술28례,국부확대절제술10례.1、3、5년무병생존솔분별위64.9％、18.5％、5.7％,1、3、5년총생존솔분별85.8％、24.1％、6.4％.종류후도≥1.51 mm、종류직경≥3 cm여림파결전이상관(x2치분별위13.093、4.449;P치분별위0.011、0.020),차종류후도역여원처전이상관(x2=11.965,P=0.018).단인소분석현시,술후보조치료여무병생존상관(x2=7.441,P=0.006);종류후도、림파결전이、림상분기여총생존상관(x2치분별위16.741、16.474、16.775;P치분별위0.002、0.000、0.000).다인소분석현시,술후보조치료위무병생존적독립위험인소(95％CI 1.420～17.621,P=0.012);종류후도、림파결전이위총생존적독립위험인소(95％ CI 0.250～0.949,P=0.035;95％ CI 1.033～2.573,P=0.036).결론 조기진단、합리선택수술방식、중시면역치료적다학과협작진료시제고항관직장악성흑색소류환자생존질량、연장생존기적관건.
Objective To investigate the diagnosis and treatment of anorectal malignant melanoma,in order to regulate surgical methods and explore multi-modality treatment.Methods Clinical pathological features,diagnosis and treatment procedures of 38 patients with anorectal melanoma were reviewed,and their correlation with prognosis were analyzed.Results In 38 patients,10 of them were male and 28 were female,with the mean age of 58.7 years old (ranged 28-75 years old).28 patients underwent abdominoperineal resection,10 patients underwent wide local excision.The 1-,3-,and 5-year disease-free survival rates were 64.9 ％,18.5 ％ and 5.7 ％,respectively.The 1-,3-,and 5-year overall survival rates were 85.8 ％,24.1％ and 6.4 ％,respectively.Tumor thickness (≥ 1.51 rm) and tumor diameter (≥3 cm) were associated with lymph metastases (x2 =13.093,4.449,P =0.011,0.020),tumor thickness was also associated with distant metastases (x2 =11.965,P =0.018).According to the Kaplan-Meier method,comprehensive treatment after surgery had significant effects on disease-free survival (x2 =7.441,P =0.006).Tumor thickness,lymph metastases,and clinical staging had significant effects on overall survival (x2 =16.741,16.474,16.775,P =0.002,0.000,0.000).Cox proportional hazards model indicated that comprehensive treatment after surgery was the independent prognostic risk factors of disease-free survival (95 ％ CI 1.420-17.621,P =0.012).Tumor thickness and lymph metastases were the independent prognostic risk factors of overall survival (95 ％ CI 0.250-0.949,1.033-2.573,P =0.035,0.036).Conclusion Early detection,reasonable surgical procedure,generalized systemic focus on immunotherapy treatment are the key to improve quality of life and prolong the survival time of anorectal malignant melanoma patients.
