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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2022, Vol. 11 ›› Issue (02) : 135 -140. doi: 10.3877/cma.j.issn.2095-3224.2022.02.007

论著

87例肛管直肠恶性黑色素瘤临床分析
原江亮1, 江波2, 刘海义2, 张毅勋2,†(), 白文启2, 王文渊2   
  1. 1. 048000　山西省晋城市人民医院普外科一病区
    2. 030013　太原，山西省肿瘤医院结直肠肛门外科
  • 收稿日期:2021-02-23 出版日期:2022-04-25
  • 通信作者: 张毅勋
  • 基金资助:
    山西省医学重点科研项目(2020XM58)

Clinicopathological features of 87 cases of anorectal malignant melanoma

Jiangliang Yuan1, Bo Jiang2, Haiyi Liu2, Yixun Zhang2,†(), Wenqi Bai2, Wenyuan Wang2   

  1. 1. Department of General Surgery, Jincheng People's Hospital, Jincheng 048000, China
    2. Department of Colorectal and Anal Surgery,Shanxi Provine Cancer Hospital, Taiyuan 030013, China
  • Received:2021-02-23 Published:2022-04-25
  • Corresponding author: Yixun Zhang
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引用本文：

原江亮, 江波, 刘海义, 张毅勋, 白文启, 王文渊. 87例肛管直肠恶性黑色素瘤临床分析[J]. 中华结直肠疾病电子杂志, 2022, 11(02): 135-140.

Jiangliang Yuan, Bo Jiang, Haiyi Liu, Yixun Zhang, Wenqi Bai, Wenyuan Wang. Clinicopathological features of 87 cases of anorectal malignant melanoma[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(02): 135-140.

目的

分析肛管直肠恶性黑色素瘤（ARMM）患者临床病理特征并进一步比较不同TNM分期及非手术与手术治疗患者的预后差异，进而探讨ARMM的有效治疗方案。

方法

回顾性分析2006~2017年就诊于山西省肿瘤医院结直肠外科的87例ARMM患者的病历资料，包括性别、年龄、肿瘤分期、免疫组化标志物：AE1/AE3、HMB45、S-100及Vimentin。探讨影响ARMM患者预后的因素，并进一步探究Ⅰ+Ⅱ期、Ⅲ期、Ⅳ期患者进行手术治疗及非手术治疗预后的关系。

结果

87例患者年龄、性别、AE1/AE3、HMB45及S-100等因素对预后影响无统计学意义，Ⅰ+Ⅱ期患者预后好于Ⅳ期患者，差异有统计学意义（P＜0.05）。52例接受手术治疗，35例接受非手术治疗（包括放弃治疗），手术组预后要明显好于非手术组，差异具有统计学意义（χ2=13.2，P＜0.05）。其中Ⅰ+Ⅱ、Ⅲ期患者，接受手术治疗预后要明显好于非手术治疗，差异具有统计学意义，但不同手术方式对预后影响无统计学意义（P＞0.05）；Ⅳ期患者，手术治疗或非手术治疗对预后影响无统计学意义（P＞0.05），但Ⅳ期手术患者，局部切除预后好于腹会阴联合切除（APR），差异有统计学意义（P＜0.05）。

结论

ARMM预后差，Ⅰ、Ⅱ、Ⅲ期患者，建议行手术治疗，包括局部切除及APR手术切除，Ⅳ期患者，首选肿瘤局部切除。

关键词: 直肠肿瘤, 病理特征, 黑色素瘤, 预后
Objective

By collect the clinicopathological characteristics of patients with anorectal malignant melanoma (ARMM), and analysis the prognostic differences between different TNM stages and non-surgical & surgical treatment groups. To find the effective treatment for ARMM.

Methods

We retrospective analysis of 87 ARMM patients clinical information,they were treated in the Colorectal Surgery Department of Shanxi Cancer Hospital from 2006 to 2017. The clinical features including gender, age, tumor stage, and immunohistochemical markers: AE1/AE3, HMB45, S-100 and Vimentin. Aim to find the factors associatied with the prognosis of ARMM, and to compare the difference of surgical treatment and non-surgical treatment group among stage Ⅰ+Ⅱ, stage Ⅲ, and stage Ⅳ.

Results

Our results showed that age, gender, AE1/AE3, HMB45, S-100 had no significant effect on ARMM patients prognosis. However, patients with stage Ⅰ+Ⅱ had better prognosis than patients with stage Ⅳ, and the result had statistical significance (P＜0.05). In our results, fifty-two patients received surgical treatment, and 35 received non-surgical treatment (including giving up treatment). The prognosis of the surgical group was significantly better than the non-surgical group (χ2=13.2, P＜0.05). For patients with stage Ⅰ+Ⅱ and Ⅲ, the prognosis of surgical treatment was significantly better than non-surgical treatment (P＜0.05), but the effect of surgical methods on prognosis was no difference (P＞0.05). In patients with stage Ⅳ, the prognosis of local resection was better than abdominoperineal resection (APR) (P＜0.05).

Conclusion

ARMM has a poor prognosis. Compared with non-surgical treatment, surgical treatment may be a better treatment way to improve the survival rate of patients. For stage I, II, and III patients, local excision is the preferred surgical approach.

Key words: Rectal neoplasms, Pathological features, Melanoma, Prognosis
图1 年龄、性别、TNM分期、免疫组化结果与患者生存期。1A：87例患者按不同年龄、性别及TNM分期分组生存曲线；1B：87例患者按AE1/AE3、S-100、HMB45及Vim是否为阴性和阳性分组生存曲线
表1 87例患者病理特征及生存期单因素分析
临床病理因素 例数 中位生存时间（月） 检验值 P值
性别 0.95 0.33

男

 28 16.6

女

 59 17.9
年龄 0.01 0.91

≤60

 48 18.7

＞60

 39 16.2
TNM分期 5.46 ＜0.05

Ⅰ+Ⅱ期

 25 20.4

Ⅲ期

 29 19.2

Ⅳ期

 25 12.2

缺失

 8 10.1
AE1/AE3 0.36 0.55

阳性

 6 9.8

阴性

 60 18.7
S-100 0.07 0.75

阳性

 64 16.2

阴性

 6 28.1
HMB45 0.29 0.5

阳性

 65 16.5

阴性

 4 9.9
Vim 1.23 0.27

阳性

 42 15.85

阴性

 3 -
图2 Ⅰ+Ⅱ、Ⅲ、Ⅳ期患者治疗方案及术式与患者生存期。2A：全部患者预后分析生存曲线；2B：Ⅰ+Ⅱ期患者预后分析生存曲线；2C：Ⅲ期患者预后分析生存曲线；2D：Ⅳ期患者预后分析生存曲线
[1]
Hillenbrand A, Barth TF, Henne-Bruns D, et al. Anorectal amelanotic melanoma[J]. Colorectal Dis, 2008, 10(6): 612-615.
[2]
Malaguarnera M, Giordano M, Rando A, et al. Intestinal lymphoma: a case report[J]. Eur Rev Med Pharmacol Sci, 2011, 15(11): 1347-1351.
[3]
Nakhleh RE, Wick MR, Rocamora A, et al. Morphologic diversity in malignant melanomas[J]. Am J Clin Pathol, 1990, 93(6): 731-740.
[4]
Balachandra B, Marcus V, Jass JR. Poorly differentiated tumours of the anal canal: a diagnostic strategy for the surgical pathologist[J]. Histopathology, 2007, 50(1): 163-174.
[5]
Belli F, Gallino GF, Lo Vullo S, et al. Melanoma of the anorectal region: the experience of the National Cancer Institute of Milano[J]. Eur J Surg Oncol, 2009, 35(7): 757-762.
[6]
Atak I. Anorectal malignant melanoma: retrospective analysis of six patients and review of the literature [J]. Prague Med Rep, 2018, 119(2-3): 97-106.
[7]
Wang S, Sun S, Liu X, et al. Endoscopic diagnosis of primary anorectal melanoma[J]. Oncotarget, 2017, 8(30): 50133-50140.
[8]
Mikkelsen LH, Larsen AC, von Buchwald C, et al. Mucosal malignant melanoma - a clinical, oncological, pathological and genetic survey[J]. APMIS, 2016, 124(6): 475-486.
[9]
冯亚光, 韩灵雨, 徐烨, 等. 原发性肛管直肠恶性黑色素瘤的临床特征和预后因素研究[J]. 中华消化杂志, 2021, 41(4): 247-252.
[10]
Meguerditchian AN, Meterissian SH, Dunn KB. Anorectal melanoma: diagnosis and treatment[J]. Dis Colon Rectum, 2011, 54(5): 638-644.
[11]
Gupta R, Singh AK, Dhagam S. Metastatic anorectal melanoma[J]. J Gastrointest Surg, 2020, 24(11): 2693-2695.
[12]
Dodds TJ, Wilmott JS, Jackett LA, et al. Primary anorectal melanoma: clinical, immunohistology and DNA analysis of 43 cases[J]. Pathology, 2019, 51(1): 39-45.
[13]
Nagarajan P, Piao J, Ning J, et al. Prognostic model for patient survival in primary anorectal mucosal melanoma: stage at presentation determines relevance of histopathologic features[J]. Mod Pathol, 2020, 33(3): 496-513.
[14]
Wang S, Sun S, Liu X, et al. Endoscopic diagnosis of gastrointestinal melanoma[J]. Scand J Gastroenterol, 2020, 55(3): 330-337.
[15]
Bohan S, Ramli Hamid MT, Poh KS, et al. Primary anorectal malignant melanoma: A clinical, radiology and pathology correlation[J]. Malays J Pathol, 2020, 42(3): 461-467.
[16]
Charifa A, Zhang X. Morphologic and immunohistochemical characteristics of anorectal melanoma [J]. Int J Surg Pathol, 2018, 26(8): 725-729.
[17]
Kado S, Maekawa T, Kamiya K, et al. Case of primary anorectal malignant melanoma treated with adjuvant immunotherapy[J]. J Dermatol, 2020, 47(12): e435-e436.
[18]
Lian J, Xu A, Chu Y, et al. Early primary anorectal malignant melanoma treated with endoscopic submucosal dissection: a case report[J]. Int J Colorectal Dis, 2020, 35(5): 959-961.
[19]
Menon H, Patel RR, Cushman TR, et al. Management and outcomes of primary anorectal melanoma in the United States[J]. Future Oncol, 2020, 16(8): 329-338.
[20]
Jutten E, Kruijff S, Francken AB, et al. Surgical treatment of anorectal melanoma: a systematic review and meta-analysis[J]. BJS Open, 2021, 5(6): zrab107.
[21]
Yang HM, Hsiao SJ, Schaeffer DF, et al. Identification of recurrent mutational events in anorectal melanoma[J]. Mod Pathol, 2017, 30(2): 286-296.
[22]
Newell F, Kong Y, Wilmott JS, et al. Whole-genome landscape of mucosal melanoma reveals diverse drivers and therapeutic targets[J]. Nat Commun, 2019, 10(1): 3163.
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