论文部分内容阅读
目的探讨生殖系统原发性恶性黑色素瘤的诊断、治疗及预后影响因素。方法对42例生殖系统原发性恶性黑色素瘤患者的临床和病理资料进行回顾性分析。结果 42例患者中,原发于外阴、阴道及宫颈的恶性黑色素瘤患者分别为14例(33%)、23例(55%)及5例(12%)。其中,38例手术治疗前行肿瘤组织活检,6例误诊,术前误诊率为16%;18例术后行免疫组化 S-100蛋白检测,18例(100%)均阳性;16例术后行抗黑色素瘤特异性抗体(HMB-45)检测,14例(88%)阳性。本组患者的2年、5年累积无瘤生存率分别为35%及23%,2年、5年累积总生存率分别为53%及27%。按国际妇产科联盟(FIGO,2000年)的分期标准,Ⅰ、Ⅱ期(早期)和Ⅲ、Ⅳ期(晚期)患者的2年累积总生存率分别为77%及34%,两者比较,差异有统计学意义(P<0.05);Ⅰ、Ⅱ期患者的2年累积总生存率分别为78%及74%,两者比较,差异无统计学意义(P=0.303)。对40例接受手术治疗患者的临床资料进行单因素分析显示,术后辅助化疗对患者的累积无瘤生存率和累积总生存率有明显影响(P<0.05);广泛性手术、区域淋巴结切除、生物治疗对预后则无明显影响(P>0.05)。化疗联合生物治疗和单纯化疗患者的2年累积无瘤生存率分别为49%及34%,两者比较,差异无统计学意义(P>0.05)。结论生殖系统原发性恶性黑色素瘤术前活检的误诊率高,应用免疫组化染色检测可提高诊断的准确性。FIGO 分期难以准确评价早期患者的预后。手术是主要治疗手段,术后辅助化疗可显著改善患者的预后。
Objective To investigate the diagnosis, treatment and prognostic factors of primary malignant melanoma in reproductive system. Methods The clinical and pathological data of 42 patients with primary malignant melanoma of reproductive system were retrospectively analyzed. Results Of the 42 patients, 14 (33%), 23 (55%) and 5 (12%) patients had malignant melanoma, which originated in the vulva, vagina and cervix. Tumor biopsy was performed in 38 cases before surgery, and 6 cases were misdiagnosed. The preoperative misdiagnosis rate was 16%. In 18 cases, immunohistochemical S-100 protein was detected in 18 cases (100%), and 16 cases After anti-melanoma antibody (HMB-45) detection, 14 cases (88%) were positive. The 2-year and 5-year cumulative tumor-free survival rates were 35% and 23% respectively in this group. The cumulative 5-year and 5-year cumulative survival rates were 53% and 27% at 2 years and 5 years, respectively. According to the criteria of the International Union of Gynecology and Obstetrics (FIGO, 2000), the 2-year cumulative overall survival rates of stage I, II (early stage) and stage III, IV (late stage) were 77% and 34% respectively , The difference was statistically significant (P <0.05). The 2-year cumulative overall survival rates of stage I and II patients were 78% and 74%, respectively. There was no significant difference between the two groups (P = 0.303). The univariate analysis of the clinical data of 40 patients undergoing surgery showed that the postoperative adjuvant chemotherapy had a significant effect on the cumulative disease-free survival rate and cumulative overall survival rate (P <0.05); extensive surgery, regional lymph node dissection, Biological treatment had no significant effect on prognosis (P> 0.05). The 2-year cumulative tumor-free survival rates of chemotherapy combined with biotherapy and chemotherapy alone were 49% and 34%, respectively. There was no significant difference between the two groups (P> 0.05). Conclusion The misdiagnosis rate of preoperative biopsy of primary malignant melanoma in reproductive system is high. The detection of immunohistochemical staining can improve the diagnostic accuracy. FIGO staging is difficult to accurately assess the prognosis of early patients. Surgery is the main treatment, postoperative adjuvant chemotherapy can significantly improve the prognosis of patients.