摘要
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 analyze the clinical characteristics, diagnosis, treatment and prognosis of primary malignant melanoma in female genital tract. Methods The clinical data of 42 patients of primary malignant melanoma in female genital tract were reviewed. Results The tumors were originated from vulva, vagina and cervix in 14 （33%）, 23 （55%） and 5 （ 12% ） eases, respectively. Thirty-eight eases had biopsies. Among them, 6 eases were misdiagnosed. Eighteen surgical specimens were examined by immunohistochemistry assays. S-100 protein was positive in all eases, and monoclonal antibody to melanoma of human（ HMB-45 ） was positive in 14 cases. The 2-year and 5-year cumulative recurrence-free survival rates were 35% and 23% respectively, while the 2-year and 5-year cumulative overall survival rates were 53% and 27% respectively. The 2-year cumulative overall survival rates for the patients of early stage [International Federation of Gynecology and Obstetrics（FIGO） stage Ⅰ and Ⅱ ] and that of advanced stage （stage Ⅲ and Ⅳ ） were 77% and 34% respeetively（P 〈0.05）. The 2-year cumulative overall survival rates for the patients of stage Ⅰ and stage Ⅱ were 78% and 74% respectively（P = 0. 303 ）. In the 40 patients who received surgery, univariate analysis showed that the adjuvant chemotherapy improved the recurrence-free survival and the overall survival significantly （ P 〈 0. 05 ）, and the other factors including radical surgery, regional lymphadeneetomy, biotherapy and radiotherapy did not affect prognosis （P 〉 0. 05 ） . Compared with chemotherapy, biochemotherapy did not improve prognosis significantly （ P 〉 0. 05 ） . Conclusions Biopsy for the malignant melanoma in female genital tract has high misdiagnosis rate. Immunohistochemistry assay could improve diagnosis markedly. The FIGO staging system fails to predict the prognosis accurately. Surgery plays an important role in treatment, while the adjuvant chemotherapy could improve survival effectively.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2007年第5期320-324,共5页
Chinese Journal of Obstetrics and Gynecology
关键词
黑色素瘤
生殖器肿瘤
女性
肿瘤分期
预后
Melanoma
Genital neoplasms, female
Neoplasm staging
Prognosis
