口腔黏膜恶性黑色素瘤肺转移特征及预后分析

韩如雪; 梁翔; 马旭辉; 郭伟; 吴云腾; 任国欣

doi:10.19401/j.cnki.1007-3639.2022.12.006

您当前的位置：

首页 >

文章列表页 >

口腔黏膜恶性黑色素瘤肺转移特征及预后分析

论著 | 更新时间：2025-12-31

- 口腔黏膜恶性黑色素瘤肺转移特征及预后分析
- Characteristics and prognostic analysis of oral mucosal melanoma with lung metastasis
- 中国癌症杂志 2022年32卷第12期页码：1184-1189
- 作者机构：
  
  1. 潍坊医学院口腔医学院，山东潍坊 261000
  2. 上海交通大学医学院附属第九人民医院，口腔颌面-头颈肿瘤科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海 200011
  3. 上海交通大学医学院附属第九人民医院胸外科，上海 200011
- 作者简介：
  
  [ "韩如雪。" ]
  任国欣。
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2022.12.006
  中图分类号： R739.8
- 收稿：2022-07-24，
  
  修回：2022-12-24，
  
  纸质出版：2022-12-30
- 稿件说明：
移动端阅览
韩如雪, 梁翔, 马旭辉, 等. 口腔黏膜恶性黑色素瘤肺转移特征及预后分析[J]. 中国癌症杂志, 2022,32(12):1184-1189.

Ruxue HAN, Xiang LIANG, Xuhui MA, et al. Characteristics and prognostic analysis of oral mucosal melanoma with lung metastasis[J]. China Oncology, 2022, 32(12): 1184-1189.
韩如雪, 梁翔, 马旭辉, 等. 口腔黏膜恶性黑色素瘤肺转移特征及预后分析[J]. 中国癌症杂志, 2022,32(12):1184-1189. DOI： 10.19401/j.cnki.1007-3639.2022.12.006.

Ruxue HAN, Xiang LIANG, Xuhui MA, et al. Characteristics and prognostic analysis of oral mucosal melanoma with lung metastasis[J]. China Oncology, 2022, 32(12): 1184-1189. DOI： 10.19401/j.cnki.1007-3639.2022.12.006.

摘要

背景与目的：

口腔黏膜恶性黑色素瘤（oral mucosal melanoma，OMM）是一类高度恶性的实体肿瘤，其远处转移率约40%，其中肺是最常见的远处转移部位；本研究旨在探讨OMM肺转移特征及预后影响因素，以期找到肺转移OMM最佳的治疗模式。

方法：

回顾性分析2017年1月—2021年1月于上海交通大学医学院附属第九人民医院确诊的肺转移OMM病例，总结胸部计算机体层成像（computed tomography，CT）的影像学特征，采用Kaplan-Meier方法进行生存分析。

结果：

88%的OMM患者在术后2年内确诊肺转移，其中第1年22例（52%），第2年15例（36%）；71%的患者胸部CT表现为大小不一、多发、圆形或椭圆形结节，寡转移少见（10%）；不按期随访（

= 0.009）、合并局部复发（

= 0.037）、合并胸腔积液（

= 0.042）以及未行免疫治疗（

= 0.000）会显著缩短患者的生存期。合并复发的患者对程序性死亡[蛋白

]

-1（programmed death-1，PD-1）免疫治疗的应答显著降低（

= 0.009），PD-1单药治疗的中位生存期只有10个月，联合抗血管靶向药物后中位生存期可延长至19个月（

=0.019）。

结论：

OMM易发生肺转移，即使小于1 cm的微小结节也可以发生转移灶。OMM转移最常发生在术后1~2年内，定期随访一定程度上能及早发现转移病灶从而延长患者的生存期。既复发又转移的OMM患者接受单纯免疫治疗往往效果欠佳，联合抗血管靶向治疗也许会有更好的治疗结局。

Abstract

Background and purpose:

Oral mucosal malignant melanoma (OMM) is a highly malignant solid tumor with a distant metastasis rate of about 40%. The lung is the most common metastatic site. This study aimed to investigate the characteristics and prognostic analysis of OMM with lung metastasis

in order to find the best treatment m

ode for OMM with lung metastasis.

Methods:

The data of the patients with lung metastasis diagnosed in the Ninth People’s Hospital Affiliated to the Medical College of Shanghai Jiao Tong University from January 2017 to January 2021 were retrospectively analyzed. The imaging characteristics of chest computed tomography (CT) were summarized

and Kaplan-Meier method was used for survival analysis.

Results:

In this study

88% of patients with OMM were diagnosed with lung metastasis within 2 years after operation

including 22 cases (52%) in the first year and 15 cases (36%) in the second year; 71% of patients showed multiple

round or oval nodules of different sizes on chest CT

and few single metastases (10%). Non-scheduled follow-up (

= 0.009)

concurrent local recurrence (

= 0.037)

concurrent pleural effusion (

= 0.042) and no immunotherapy (

= 0.000) could significantly reduce the survival time of patients. The response of patients with relapse to programmed death-1 (PD-1) immunotherapy was significantly reduced (

= 0.009)

and the median overall survival (OS) of PD-1 single drug was only 10 months. After combination therapy with PD-1 and anti-vascular targeted drugs

the median OS could be increased to about 19 months (

= 0.019).

Conclusion:

OMM is prone to lung metastasis

and even tiny nodules less than 1cm can be metastatic foci. The metastasis of OMM most often occurs within 1-2 years after operation. Regular follow-up can detect early metastasis and significantly prolong the survival. The efficacy of immunotherapy alone for recurrent and metastatic OMM is also poor

and immunotherapy combined with anti-vascular targeted therapy is required.

关键词

Keywords

references

SUN C Z , LI Q L , HU Z D , et al . Treatment and prognosis in sinonasal mucosal melanoma: a retrospective analysis of 65 patients from a single cancer center [J ] . Head Neck , 2014 , 36 ( 5 ): 675 - 681 . DOI: 10.1002/hed.23355 http://doi.org/10.1002/hed.23355 https://onlinelibrary.wiley.com/doi/10.1002/hed.23355 https://onlinelibrary.wiley.com/doi/10.1002/hed.23355

ASCIERTO P A , ACCORONA R , BOTTI G , et al . Mucosal melanoma of the head and neck [J ] . Crit Rev Oncol Hematol , 2017 , 112 : 136 - 152 . DOI: S1040-8428(17)30045-8 http://doi.org/S1040-8428(17)30045-8

CHENG Y F , LAI C C , HO C Y , et al . Toward a better understanding of sinonasal mucosal melanoma: clinical review of 23 cases [J ] . J Chin Med Assoc , 2007 , 70 ( 1 ): 24 - 29 . DOI: 10.1016/S1726-4901(09)70296-5 http://doi.org/10.1016/S1726-4901(09)70296-5 https://journals.lww.com/02118582-200701000-00006 https://journals.lww.com/02118582-200701000-00006

FAURE M , ROCHIGNEUX P , OLIVE D , et al . Hyperprogressive disease in anorectal melanoma treated by PD-1 inhibitors [J ] . Front Immunol , 2018 , 9 : 797 . DOI: 10.3389/fimmu.2018.00797 http://doi.org/10.3389/fimmu.2018.00797

SUN S , HUANG X , GAO L , et al . Long-term treatment outcomes and prognosis of mucosal melanoma of the head and neck: 161 cases from a single institution [J ] . Oral Oncol , 2017 , 74 : 115 . DOI: S1368-8375(17)30298-1 http://doi.org/S1368-8375(17)30298-1

MA X H , WU Y T , ZHANG T , et al . Ki67 proliferation index as a histopathological predictive and prognostic parameter of oral mucosal melanoma in patients without distant metastases [J ] . J Cancer , 2017 , 8 ( 18 ): 3828 - 3837 . DOI: 10.7150/jca.20935 http://doi.org/10.7150/jca.20935

GRÖZINGER G , MANN S , MEHRA T , et al . Metastatic patterns and metastatic sites in mucosal melanoma: a retrospective study [J ] . Eur Radiol , 2016 , 26 ( 6 ): 1826 - 1834 . DOI: 10.1007/s00330-015-3992-9 http://doi.org/10.1007/s00330-015-3992-9

梁翔 , 吴云腾 . 伴复发转移的口腔黏膜黑色素瘤长期生存患者的临床特征及预后分析 [J ] . 中国癌症杂志 , 2020 , 30 ( 7 ): 531 - 537 .

LIANG X , WU Y T . Clinical characteristics and prognosis of long-term survivors of oral mucosal melanoma with recurrence and metastasis [J ] . China Oncol , 2020 , 30 ( 7 ): 531 - 537 .

吴云腾 , 任国欣 , 孙沫逸 , 等 . 中国头颈黏膜黑色素瘤临床诊治专家共识 [J ] . 中国口腔颌面外科杂志 , 2015 , 13 ( 3 ): 262 - 269 .

WU Y T , REN G X , SUN M Y , et al . Chinese expert consensus document on head and neck mucosal malignant melanoma [J ] . China J Oral Maxillofac Surg , 2015 , 13 ( 3 ): 262 - 269 .

SUN S R , HUANG X D , GAO L , et al . Long-term treatment outcomes and prognosis of mucosal melanoma of the head and neck: 161 cases from a single institution [J ] . Oral Oncol , 2017 , 74 : 115 - 122 . DOI: S1368-8375(17)30298-1 http://doi.org/S1368-8375(17)30298-1

SAMSTEIN R M , CARVAJAL R D , POSTOW M A , et al . Localized sinonasal mucosal melanoma: outcomes and associations with stage, radiotherapy, and positron emission tomography response [J ] . Head Neck , 2016 , 38 ( 9 ): 1310 - 1317 . DOI: 10.1002/hed.24435 http://doi.org/10.1002/hed.24435 https://onlinelibrary.wiley.com/doi/10.1002/hed.24435 https://onlinelibrary.wiley.com/doi/10.1002/hed.24435

GANTALA R , JANGILI U , KATNE T , et al . Oral mucosal melanoma: a case report [J ] . J Indian Acad Oral Med Radiol , 2017 , 29 ( 1 ): 39 . DOI: 10.4103/jiaomr.JIAOMR_140_16 http://doi.org/10.4103/jiaomr.JIAOMR_140_16 http://www.jiaomr.in/text.asp?2017/29/1/39/212081 http://www.jiaomr.in/text.asp?2017/29/1/39/212081

OWEN C N , SHOUSHTARI A N , CHAUHAN D , et al . Management of early melanoma recurrence despite adjuvant anti-PD-1 antibody therapy [J ] . Ann Oncol , 2020 , 31 ( 8 ): 1075 - 1082 . DOI: S0923-7534(20)39788-X http://doi.org/S0923-7534(20)39788-X

COCOROCCHIO E , PALA L , CONFORTI F , et al . Successful treatment with avapritinib in patient with mucosal metastatic melanoma [J ] . Ther Adv Med Oncol , 2020 , 12 : 1758835920946158.

ZIMMER L , LIVINGSTONE E , HASSEL J C , et al . Adjuvant nivolumab plus ipilimumab or nivolumab monotherapy versus placebo in patients with resected stage Ⅳ melanoma with no evidence of disease (IMMUNED): a randomised, double-blind, placebo-controlled, phase 2 trial [J ] . Lancet , 2020 , 395 ( 10236 ): 1558 - 1568 . DOI: 10.1016/S0140-6736(20)30417-7 http://doi.org/10.1016/S0140-6736(20)30417-7 https://linkinghub.elsevier.com/retrieve/pii/S0140673620304177 https://linkinghub.elsevier.com/retrieve/pii/S0140673620304177

SHENG X , YAN X , CHI Z , et al . Axitinib in combination with toripalimab, a humanized immunoglobulin G4 monoclonal antibody against programmed cell death-1, in patients with metastatic mucosal melanoma: an open-label phase ⅠB trial [J ] . J Clin Oncol , 2019 , 37 ( 32 ): 2987 - 2999 . DOI: 10.1200/JCO.19.00210 http://doi.org/10.1200/JCO.19.00210 https://ascopubs.org/doi/10.1200/JCO.19.00210 https://ascopubs.org/doi/10.1200/JCO.19.00210

CHAE Y S , LEE J Y , LEE J W , et al . Survival of oral mucosal melanoma according to treatment, tumour resection margin, and metastases [J ] . Br J Oral Maxillofac Surg , 2020 , 58 ( 9 ): 1097 - 1102 . DOI: 10.1016/j.bjoms.2020.05.028 http://doi.org/10.1016/j.bjoms.2020.05.028

浏览量

2664

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

胰腺癌器官特异性肺转移机制的研究进展

铂类药物敏感复发卵巢癌患者的三步化疗法附20例分析

原发性心脏高级别B细胞淋巴瘤化疗缓解后复发1例报告

河北医科大学第四医院前列腺癌患者的基线特征与生存分析

32例颌面部骨肉瘤临床特点比较及预后影响因素分析