黏膜型黑色素瘤术后辅助治疗预后分析
Prognostic Analysis of Postoperative Adjuvant Therapy for Mucosal Melanoma
DOI: 10.12677/acm.2025.15123531, PDF,   
作者: 曾 龙, 毛萌洁, 王春语：成都中医药大学医学与生命科学学院，四川 成都；陶清秀, 鲁迎春：电子科技大学医学院，四川 成都；柳 斌*：电子科技大学附属肿瘤医院肿瘤内科，四川 成都
关键词: 黏膜型恶性黑色素瘤；术后辅助治疗；复发转移；生存分析；预后模型；Mucosal Melanoma； Postoperative Adjuvant Therapy； Recurrence and Metastasis； Survival Analysis； Prognostic Model
摘要: 目的：分析黏膜型恶性黑色素瘤(mucosal melanoma, MuM)根治术后辅助治疗预后影响因素，构建风险分层模型。方法：收集2014年1月~2024年1月四川省肿瘤医院78例MuM术后患者资料，采用Kaplan-Meier法计算生存率，Cox回归分析预后因素并建立Nomogram(诺莫图)模型。结果：中位随访时间65.5个月，总体复发转移率43.6%。多因素分析显示术后放化疗联合可显著减少复发风险(HR = 0.45, 95% CI: 0.22~0.92)，而术前淋巴结转移(HR = 2.10, 95% CI: 1.30~3.40)及高Ki-67抗原(Ki-67 Antigen, Ki-67)表达趋势性增加风险是独立危险因素。Nomogram模型总评分与复发风险呈梯度关联：高评分提示较低复发风险，对应较高无病生存期(disease-free survival, DFS)，而低评分提示较高复发风险，对应较低DFS。结论：术后放化疗联合可降低MuM复发风险，但合并淋巴结转移及高Ki-67表达者预后不良。建立的Nomogram模型能有效评估复发风险，临床需关注骨髓抑制等不良反应。建议开展多中心研究验证模型效能，并探索联合靶向治疗、免疫检查点抑制剂及循环肿瘤脱氧核糖核酸(Circulating Tumor Deoxyribonucleic Acid, ctDNA)监测的个体化治疗策略。
Abstract: Objective: To analyze prognostic factors influencing recurrence in mucosal melanoma (MuM) patients after radical resection and to construct a risk stratification model. Methods: Clinical data from 78 MuM patients who underwent surgery at Sichuan Cancer Hospital between January 2014 and January 2024 were retrospectively collected. Survival rates were calculated using the Kaplan-Meier method. Prognostic factors were identified by Cox regression analysis, and a Nomogram prediction model was established. Results: The median follow-up was 65.5 months. The overall recurrence/metastasis rate was 43.6%. Multivariate analysis revealed that postoperative chemoradiotherapy significantly reduced recurrence risk (HR = 0.45, 95% CI: 0.22~0.92), while preoperative lymph node metastasis (HR = 2.10, 95% CI: 1.30~3.40) and high Ki-67 expression (trending towards increased risk) were independent adverse prognostic factors. The total score of the Nomogram model shows a gradient association with the risk of recurrence: high scores indicate low recurrence risk and high disease-free survival (DFS), while low scores indicate high recurrence risk and low DFS. The incidence of treatment-related myelosuppression was 25.6%. Conclusion: Postoperative chemoradiotherapy reduces recurrence risk in MuM. However, patients with lymph node metastasis or high Ki-67 Antigen (Ki-67) expression have a poorer prognosis. The established Nomogram model effectively assesses recurrence risk. Clinical attention to adverse effects like myelosuppression is warranted. Future studies should validate this model in multicenter cohorts and explore individualized strategies incorporating targeted therapy, immune checkpoint inhibitors, and circulating tumor Deoxyribonucleic Acid (ctDNA) monitoring.
文章引用：曾龙, 毛萌洁, 王春语, 陶清秀, 鲁迎春, 柳斌. 黏膜型黑色素瘤术后辅助治疗预后分析[J]. 临床医学进展, 2025, 15(12): 1299-1309. https://doi.org/10.12677/acm.2025.15123531

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