近5年单中心肢端型及皮肤型黑色素瘤外科治疗患者的预后因素分析

林馨怡; 孙伟; 胡涂; 王春萌; 严望军; 罗志国; 刘欣; 钟景钦; 邹孜瑊; 徐宇; 陈勇

doi:10.19401/j.cnki.1007-3639.2022.12.003

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近5年单中心肢端型及皮肤型黑色素瘤外科治疗患者的预后因素分析

专题论著 | 更新时间：2025-12-31

- 近5年单中心肢端型及皮肤型黑色素瘤外科治疗患者的预后因素分析
- Multivariable prognostic analyses of Chinese acral and cutaneous melanoma after surgical treatment for the past five years in a single cancer center
- 中国癌症杂志 2022年32卷第12期页码：1158-1167
- 作者机构：
  
  1. 复旦大学附属肿瘤医院骨软组织外科，复旦大学上海医学院肿瘤学系，上海 200032
  2. 复旦大学附属肿瘤医院消化肿瘤内科，复旦大学上海医学院肿瘤学系，上海 200032
  3. 复旦大学附属肿瘤医院头颈及神经内分泌肿瘤内科，复旦大学上海医学院肿瘤学系，上海 200032
- 作者简介：
  
  [ "林馨怡（ORCID: 0000-0001-9872-2842），博士。" ]
  [ "陈勇，主任医师，副教授，硕士研究生导师。现任复旦大学附属肿瘤医院骨软组织外科副主任，复旦大学附属肿瘤医院恶性黑色素瘤诊治中心主任。现任中国抗癌协会黑色素瘤专业委员会副主任委员，上海市抗癌协会黑色素瘤专业委员会主任委员，中国抗癌协会肉瘤专业委员会常委，中国抗癌协会肉瘤专业委员会脊柱肿瘤学组委员，中国修复重建外科专业委员会骨肿瘤学组委员，中国中医药研究促进会骨伤科分会骨肿瘤专业委员会委员，上海市抗癌协会肉瘤专业委员会常委兼秘书长。从事肿瘤外科临床和科研工作20余年，擅长骨与软组织肿瘤、恶性黑色素瘤的综合治疗。先后承担国家自然科学基金和行业协会等10余项重要课题，主要负责恶性黑色素瘤、肉瘤等相关临床试验10余项，以第一作者及通信作者身份发表论文30余篇，2021年以第一完成人获“中国抗癌协会科技奖二等奖”；2017年获“上海市卫健委杰出青年”称号，2018年获“复旦大学十佳医务青年”称号。" ]
- 基金信息：
  
  国家自然科学基金面上项目(82272857);国家自然科学基金(81802636);临港实验室基金(LG-QS-202205-11);上海市科学技术委员会科研计划(19411951700)
- DOI：10.19401/j.cnki.1007-3639.2022.12.003
  中图分类号： R739.5
- 收稿：2022-11-01，
  
  修回：2022-12-12，
  
  纸质出版：2022-12-30
- 稿件说明：
移动端阅览
林馨怡, 孙伟, 胡涂, 等. 近5年单中心肢端型及皮肤型黑色素瘤外科治疗患者的预后因素分析[J]. 中国癌症杂志, 2022,32(12):1158-1167.

Xinyi LIN, Wei SUN, Tu HU, et al. Multivariable prognostic analyses of Chinese acral and cutaneous melanoma after surgical treatment for the past five years in a single cancer center[J]. China Oncology, 2022, 32(12): 1158-1167.
林馨怡, 孙伟, 胡涂, 等. 近5年单中心肢端型及皮肤型黑色素瘤外科治疗患者的预后因素分析[J]. 中国癌症杂志, 2022,32(12):1158-1167. DOI： 10.19401/j.cnki.1007-3639.2022.12.003.

Xinyi LIN, Wei SUN, Tu HU, et al. Multivariable prognostic analyses of Chinese acral and cutaneous melanoma after surgical treatment for the past five years in a single cancer center[J]. China Oncology, 2022, 32(12): 1158-1167. DOI： 10.19401/j.cnki.1007-3639.2022.12.003.

摘要

背景与目的：

中国及亚洲部分国家和地区的恶性黑色素瘤（malignant melanoma，MM）患者的预后显著低于欧美人群，主要是因为肢端型黑色素瘤（acral melanoma，AM）无论是在生物学行为、临床特征、预后以及药物的疗效（主要是免疫治疗）上都差于皮肤型黑色素瘤（cutaneous melanoma，CM）。近5年在MM外科治疗和药物辅助治疗选择方面发生了一定的变化。本文回顾性分析近5年单中心经手术治疗的AM及CM患者的生存变化和相关的独立预后因素。

方法：

对2017—2021年在复旦大学肿瘤医院黑色素瘤诊治中心接受外科治疗的MM患者进行回顾性研究。通过病史回顾和随访收集患者完整的基本信息、原发灶特点、淋巴灶转移特征和生存状态，剔除黏膜型、原发不明、随访时间短于6个月的病例。通过生存分析和多因素分析，探讨患者生存的差异和相关预后因素。

结果：

本研究共入组585例黑色素瘤患者，其中AM 397例，CM 188例。中位年龄59（19~89）岁，女性占54%。AM和CM在性别、年龄、原发灶位置、基因突变分布和辅助治疗等方面存在差异，但在Breslow深度、溃疡、淋巴结转移等肿瘤负荷因素上差异无统计学意义。中位随访时间为24个月，中位无疾病生存期为36个月，1、2年无复发生存期（relapse-free survival，RFS）分别为75.6%和61.2%。但两亚型的预后差异无统计学意义。AM中RFS的独立风险因素包括：原发灶溃疡（HR=2.265，95% CI：1.257~4.080），

NRAS

基因突变（HR=1.816，95% CI：1.211~2.725），较晚的N分期（N

、N

相较N

的HR分别为1.850、4.085、4.191）；保护因素为女性（HR=0.636，95% CI：0.433~0.933）和上肢原发灶（HR=0.259，95% CI：0.105~0.639）。CM中RFS的独立风险因素包括：原发灶溃疡（HR=4.073，95% CI：1.718~9.654），较晚的N分期（其中N

期的HR=5.482，95% CI：2.385~12.601）。

结论：

预后分析发现，原发灶的肿瘤负荷仍旧与CM和AM患者的预后密切相关，而

NRAS

基因的突变状态则提示AM预后更差。

Abstract

Background and purpose:

The prognosis of malignant melanoma (MM) in China and Asia is significantly worse than that of European and American populations

mainly because acral melanoma (AM) is inferior to cutaneous melanoma (CM) in terms of biological behavior

clinical features

prognosis

and efficacy of drugs (mainly immunotherapy). Certain changes have occurred in the last 5 years in the choice of surgical and drug-adjuvant treatment for MM. This study retrospectively analyzed the survival outcomes of Chinese CM and AM patients after surgical treatment in a single cancer center for the past five years.

Methods:

Data of melanoma patients undergoing surgical treatment were retrospectively collected from 2017 to 2021 in Fudan University Shanghai Cancer Center. The basic clinical characteristics

pathological features

lymph node tumor burden and survival information were carefully collected from medical document. Patients with mucosal subtype

unknown primary sites

or follow-up less than 6 months were excluded. Survival analysis and multivariable Cox regression analysis were performed to explore prognosis and associated risk factors.

Results:

Totally 585 patients were enrolled

including 397 AM and 188 CM patients. The median age was 59 (19-89) years

and 54% were female. AM and CM patients differed in gender

age

primary tumor location

gene mutation distribution and adjuvant therapy

but not in tumor burden associated factors including the Breslow thickness

ulceration and lymph node involvment. The median follow-up time was 24 months

and the median relapse-free survival (mRFS) was 36 months

with 1-year and 2-year RFS of 75.6% and 61.2%

respectively. However

there was no statistically significant difference in prognosis between the two subtypes. Primary ulceration (HR=2.265

95% CI: 1.257-4.080)

NRAS

mutation (HR=1.816

95% CI: 1.211-2.725) and advanced N stage (HR of N

and N

versus N

were 1.850

4.085 and 4.191

respectively) were independent prognostic risk factors for RFS in AM; while the protective factors were female (HR=0.636

95% CI: 0.433-0.933) and upper extremity primary lesions (HR=0.259

95% CI: 0.105-0.639). Independent risk factors for RFS in CM included primary ulceration (HR=4.073

95% CI: 1.718-9.654)

and later N stage (HR=5.482

95% CI: 2.385-12.601 for N

stage).

Conclusion:

High tumor burden of primay lesion still deteriorates overall outcomes for both AM and CM

while harboring

NRAS

mutation might suggest even worse outcome for AM.

关键词

Keywords

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