青岛大学附属医院口腔黏膜原发黑色素瘤住院病人生存资料分析

发布时间：2018-04-22 19:37

  本文选题：口腔黏膜原发黑色素瘤 + 临床特点　； 参考：《青岛大学》2017年硕士论文

【摘要】：目的:本文旨在对青岛大学附属医院口腔颌面外科2000年1月至2015年12月住院的26例口腔黏膜原发黑色素瘤患者的病例资料进行回顾性研究,描述其病例特点及生存资料,探讨影响其临床预后的相关因素。为我院及国内口腔黏膜原发黑色素瘤病的诊治及预后工作完善病例资料及提供数据支持,有助于提高对本病的认识和诊治水平,改善患者的预后。资料与方法:收集我科最近16年的26例口腔黏膜原发黑色素瘤患者的病例资料,所有病例均由组织病理学确诊。统计分析26例患者的临床特点,并找出患者性别、年龄、临床分期、不同治疗方式与疾病预后间的关系。且对所有治疗患者随访总生存期,估计治疗患者的3年、5年生存率和中位生存期。所有统计分析都采用SPSS19.0软件包,以P0.05为显著性标准。预后单因素分析采用Kaplan-Meier法并绘制生存曲线,Log-rank检验,以P0.05为差异有统计学意义。结果:26例口腔黏膜原发黑色素瘤患者中,男性15例,女性11例,男女比为1.36:1。总体发病年龄在40岁左右,发病高峰年龄在50~70岁,中位发病年龄为53岁。发病部位中,原发于腭黏膜12例(46.15%)、牙龈黏膜11例(42.31%)、颊黏膜3例(11.54%)。III期患者8例,IVA期患者16例,两者之比为1:2,2例患者主动放弃治疗。16例患者出现颈淋巴结转移,转移率为61.54%。行单纯原发灶扩大切除术或冷冻术的患者均2人,其复发率为50%和100%;原发灶扩大切除术+冷冻术的患者共6人,复发率为50%;原发灶扩大切除术+冷冻术+颈淋巴结清扫术的患者共10人,复发率为30%;原发灶扩大切除术+冷冻术+颈淋巴结清扫术+生物免疫化疗的患者共4人,均无复发及颈淋巴结转移和远处转移,且其平均生存时间为8年10个月。24例患者的3年、5年生存率分别为41.7%和25%,中位生存期为30个月,III期和IVA期患者的3年、5年生存率分别为25%、25%;50%、25%。单因素预后分析显示,患者性别、年龄(≥56岁和56岁)和临床分期(III期和IVA期)与患者的预后相关性没有统计学差异(P0.05),不同治疗方式之间差异有统计学意义,即不同治疗方式与患者的预后存在相关性(P0.05)。结论:1.青大附院口腔黏膜原发黑色素瘤患者男:女=1.36:1,总体高发年龄为50~70岁。高发部位为腭部黏膜和牙龈黏膜。2.青大附院口腔黏膜原发黑色素瘤患者IVA期(16例):III期(8例)=2:1。行原发灶扩大切除术+冷冻术+颈淋巴结清扫术+生物免疫化疗的患者生存时间、局部复发和颈淋巴结转移及远处转移均优于单纯行原发灶扩大切除术+冷冻术+颈部淋巴结清扫术的患者。3.24例患者的3年、5年生存率分别约为41.7%和25%,中位生存期为30个月。4.24例患者口腔黏膜原发黑色素瘤的预后与患者的性别、年龄和临床分期相关性无统计学差异,与患者的不同治疗方式差异有统计学意义。
[Abstract]:Objective: to study retrospectively the data of 26 patients with primary melanoma of oral mucosa who were hospitalized in oral and maxillofacial surgery of affiliated Hospital of Qingdao University from January 2000 to December 2015, and to describe their case characteristics and survival data. Objective: to explore the related factors affecting the clinical prognosis. To improve the case data and provide data support for the diagnosis, treatment and prognosis of oral mucosal primary melanoma in our hospital and China, it is helpful to improve the understanding and diagnosis of the disease and improve the prognosis of the patients. Materials and methods: 26 cases of oral mucosal primary melanoma in our department were collected in recent 16 years. All cases were confirmed by histopathology. The clinical characteristics of 26 patients were analyzed and the relationship between sex, age, clinical stage, different treatment methods and the prognosis of the disease was found out. The 3 -, 5-year survival rate and median survival time were estimated for all patients. All statistical analysis were carried out with SPSS19.0 software package, with P0.05 as the significant standard. The prognostic univariate analysis was performed by Kaplan-Meier method and the survival curve was plotted by Log-rank test. The difference was statistically significant with P0.05. Results among 26 cases of oral mucosal primary melanoma, 15 cases were male and 11 cases were female, the ratio of male to female was 1.36: 1. The age of onset was about 40 years old, the peak age was 50 ~ 70 years old, the median age was 53 years old. Among them, 12 cases originated from palatal mucosa, 11 cases from gingival mucosa and 42.31%, and 3 cases from buccal mucosa from stage 11.54 to stage III in 8 cases with IVA stage. The ratio of the two cases was 1: 22%, 2 patients gave up treatment voluntarily, 16 patients had cervical lymph node metastasis, the metastasis rate was 61.54. The recurrence rate was 50% and 100%, and 6 patients were treated with expanded resection of primary focus or cryopreservation. The recurrence rate was 50. 10 patients were treated with expanded resection of primary focus and frozen neck lymph node dissection, and the recurrence rate was 300.The total number of patients treated with biological immunotherapy for primary tumor resection and frozen neck lymph node dissection was 4. There was no recurrence, cervical lymph node metastasis and distant metastasis, and the mean survival time was 8 years, 10 months, and 24 cases, the 5-year survival rate was 41.7% and 25%, the median survival time was 30 months and 3 years for stage III and IVA patients, and the 5-year survival rate was 250.2550 and 2525, respectively. Univariate prognostic analysis showed that there was no significant difference between sex, age (鈮，

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