摘要
目的 分析非老年与老年黑色素瘤临床病理特征差异,探讨老年黑色素瘤预后的危险因素.方法 回顾性分析2008年1月至2023年12月新疆维吾尔自治区人民医院经临床及组织病理明确诊断的非老年黑色素瘤(＜60岁)与老年黑色素瘤(≥ 60岁)患者的临床及病理资料.采用卡方检验、Wilcoxon秩和检验分析两组临床病理特征的差异,采用Kaplan-Meier法估计生存曲线并行log-rank检验,采用Cox回归模型分析临床和病理变量与总生存期的关系.结果 纳入233例皮肤黑色素瘤患者,年龄(60.3±14.7)岁,60～69岁为发病高峰.非老年组102例(43.8％),老年组131例(56.2％).老年组肿瘤浸润性淋巴细胞活跃比例(P=0.040)、Ki-67指数≥ 30％比例(P=0.010)、Charlson合并症指数(P=0.002)高于非老年组,而BRAF/KIT/NRAS突变率(P=0.003)、接受手术治疗的比例(P=0.034)、接受辅助治疗的比例(P=0.042)均低于非老年组.两组总生存率差异有统计学意义(log-rank检验,x2=6.10,P=0.014).性别、转移与否、伴发溃疡与否、远处转移与否、美国癌症联合委员会肿瘤分期、Charlson合并症指数、Breslow厚度是影响老年黑色素瘤患者总生存期的重要预后指标,多因素Cox回归分析显示,男性(P=0.015,HR=4.622,95％CI:1.352～15.798)、有远处转移(P=0.013,HR=9.844,95％CI:4.621～59.763)、Charlson合并症指数 ≥3(P=0.038,HR=3.149,95％CI:1.067～9.294)是影响老年黑色素瘤患者总生存期的独立危险因素.结论 与非老年黑色素瘤相比,老年黑色素瘤患者表现出更高的Ki-67指数、更高的Charlson合并症指数、更低的手术比例、更低的辅助治疗比例等.男性、有远处转移、Charlson合并症指数≥ 3是影响总生存期的独立危险因素.
Abstract
Objective To analyze the differences in clinicopathological features between non-elderly and elderly patients with melanoma,and to identify risk factors for prognosis in elderly patients with melanoma.Methods A retrospective analysis was conducted on clinical and pathological data collected from non-elderly(aged＜60 years)and elderly(aged ≥ 60 years)patients with melanoma,who were confirmedly diagnosed according to clinical manifestations and histopathological findings at the People's Hospital of Xinjiang Uygur Autonomous Region from January 2008 to December 2023.The differences in clinical and pathological characteristics between the two groups were analyzed using the chi-square test and Wilcoxon rank-sum test.Survival curves were estimated using the Kaplan-Meier method and log-rank test.The relationship between clinicopathological variables and overall survival was analyzed using a Cox regression model.Results A total of 233 patients with cutaneous melanoma were included,with the age being 60.3±14.7 years,and the number of patients was highest in the age group of 60-69 years.There were 102 cases(43.8％)in the＜60 years old group and 131 cases(56.2％)in the ≥ 60 years old group.Compared with the＜60 years old group,the ≥ 60 years old group showed a significant increase in the proportion of patients with active tumor-infiltrating lymphocytes(P=0.040),proportion of those with Ki-67 index ≥ 30％(P=0.010),and Charlson comorbidity index(P=0.002),but a significant decrease in the proportion of patients with BRAF/KIT/NRAS mutations(P=0.003),proportion of those receiving surgical treatment(P=0.034),and proportion of those receiving adjuvant therapy(P=0.042).There was a significant difference in the overall survival between the two groups(log-rank test,x2=6.10,P=0.014).The gender,metastasis status,presence or absence of ulceration,distant metastasis status,American Joint Committee on Cancer staging,Charlson comorbidity index,and Breslow thickness were important prognostic indicators affecting the overall survival in the elderly patients with melanoma.Multivariate Cox regression analysis showed that males(P=0.015,HR=4.622,95％CI:1.352-15.798),presence of distant metastasis(P=0.013,HR=9.844,95％CI:4.621-59.763),and Charlson comorbidity index ≥ 3(P=0.038,HR=3.149,95％CI:1.067-9.294)were independent risk factors affecting the overall survival in the elderly patients with melanoma.Conclusions Compared with the non-elderly patients with melanoma,a higher Ki-67 index,a higher Charlson comorbidity index,less surgical treatment,and less adjuvant therapy were more common in the elderly patients with melanoma.Males,the presence of distant metastasis,and Charlson comorbidity index ≥ 3 appeared to be independent risk factors affecting the overall survival in the elderly patients with melanoma.
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