影响肛管直肠恶性黑色素瘤预后多因素分析.doc

影响肛管直肠恶性黑色素瘤预后多因素分析 　【摘要】 目的：探讨肛管直肠恶性黑色素瘤(anorectal malignant melanoma, AMM)的生存状况及其影响因素。方法：回顾性随访1994至2004年我院治疗的8例AMM；检索CNKI全文数据库，收集国内同期有随访资料的个案报道共48篇136例，随访时间1～144个月，分析18项与生存期可能相关的因素，单因素分析采用KaplanMeier模型的Logrank检验，多因素分析采用COX比例风险模型（SPSS10.0 for windows）。结果：AMM的1年、2年、3年、5年和10年生存率分别为47.25％、34.17％、27.28％、17.78％和8.89％，中位生存时间为16.78月。单因素分析显示肿瘤大小、肿瘤占据肠腔周径、误诊疾病类型、治疗方式、手术方式共5项因素影响AMM的预后（Plt;0.05），多因素分析显示肿瘤大小、治疗方式、手术方式影响AMM的预后（Plt;0.05）。结论：AMM预后极差，影响其预后的因素可分为两个方面：肿瘤大小和治疗方案，说明早期诊断和恰当治疗的重要性。 【关键词】 黑色素瘤 肛管 直肠 生 因素 Multivariate analysis of prognostic factors in anorectal malignant melanoma Abstract Objective: This study aimed to investigate the survival function of primary anorectal malignant melanoma (AMM) and find the influencing factors on survival. Methods: Eight patients with AMM treated in our hospital from January 1994 to december 2004 and 136 patients reported by internal literature between 1994 and december 2004 were reviewed. After constructing the database, KaplanMeier and COX analysis（SPSS10.0 for windows）were used to find out the relationship of eighteen factors to survival. Results: The overall 1，2, 3, 5, 10 year survival rates for AMM were 47.25％, 34.17％, 27.28％, 17.78％ and 8.89％ respectively, the median survival time was 16.78 months. KaplanMeier analysis found five of eighteen factor affect survival, they were the size of tumor, the tumor circumference in intestine, the diseases of misdiagnosis, therapy method and surgical mode; while COX analysis only found the size of tumor, therapy method and surgical mode close to survival. Conclusion: AMM has a very poor prognosis. The size of tumor and therapy are the main factor affect survival, and this indicates the important of early diagnosis and appropriate treatment. Key words Melanoma; Anus; Rectal; Survival; Factor 肛管直肠恶性黑色素瘤(anorectal malignant melanoma, AMM)是一种临床罕见而又恶性程度很高的肿瘤，对其预后的生存分析认为预后极差，5年生存率仅有10％左右[1]。由于病例少见，对其预后影响因素的分析极少报道。本文通过总结我院收治的原发性AMM病例结合文献复习，分析其生存状况和影响预后的相关因素。 1 对象与方法 总结随访我院1994 年1月至2