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恶性黑色素瘤肝转移患者临床特征和预后因素分析

Clinical Characteristics and Prognostic Factors of Patients with Malignant Melanoma Liver Metastasis

  • 摘要:
    目的 分析恶性黑色素瘤肝转移患者临床特征和预后因素。
    方法 回顾性收集一线全身治疗前发生肝转移的黑色素瘤患者临床资料。Kaplan-Meier生存分析评估患者临床特征与总生存期(OS)和无进展生存期(PFS)的关系。Cox回归分析确定与PFS和OS相关的预后因素。
    结果 本研究共纳入了80例患者,其中6例患者在确诊为肝转移之后未行全身或局部抗肿瘤治疗,其中位生存时间为2.3个月;其余74例患者的中位OS为12.5个月。在接受抗肿瘤全身或局部治疗的患者中,Cox回归确定了年龄、局部治疗为OS的独立预后因素,性别和血清NSE水平为全身PFS、肝内PFS的独立预后因素。一线治疗方案包括ICI对患者可能有生存获益,但差异无统计学意义(HR=0.716,P=0.255)。NRAS突变率(11.25%)最高,并且预后相对较差,另外分别有8例(10%)和4例(5%)患者检测到BRAF突变和CKIT突变。
    结论 年龄越小,行局部治疗的患者预后相对较好,一线免疫检查点抑制剂治疗可能带来潜在的生存益处。

     

    Abstract:
    Objective To analyze the clinical characteristics and prognostic factors of patients with malignant melanoma liver metastasis.
    Methods The clinical data of patients with melanoma liver metastasis before first-line systemic therapy were retrospectively collected. Kaplan–Meier survival analysis was conducted to evaluate the association of clinical characteristics with overall survival (OS) and progression-free survival (PFS). Prognostic factors associated with PFS and OS were determined through Cox regression analysis.
    Results A total of 80 patients were included in this study. Six of these patients did not receive systemic or local antitumor therapy after the diagnosis of liver metastasis. Their median survival time after the diagnosis of liver metastasis was 2.3 months. The median OS of the remaining 74 patients was 12.83 months. Cox regression analysis determined that in the patients receiving systemic or local antitumor therapy, age and local treatment were independent prognostic factors for OS; gender and serum NSE levels were independent prognostic factors for systemic PFS and intrahepatic PFS. First-line treatment including immune checkpoint inhibitors (ICIs) may have survival benefits for patients but the difference was not statistically significant (HR=0.716, P=0.255). Among gene mutations, NRAS mutations had the highest rates (11.25%) and were associated with poor prognosis. In addition, BRAF and CKIT mutations were detected in eight (10%) and four (5%) patients, respectively.
    Conclusion Patients who are younger and receive local treatment have a relatively better prognosis. The first-line ICI therapy may have survival benefits for patients.

     

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