44例原發(fā)性陰道惡性黑色素瘤患者的回顧性臨床病理分析.pdf

1、復旦大學博士學位論文44例原發(fā)性陰道惡性黑色素瘤患者的回顧性臨床病理分析姓名：夏玲芳申請學位級別：博士專業(yè)：腫瘤學（婦科腫瘤學）指導教師：吳小華20120410AbstractObjective：Primarymalignantmelanomaofthevaginaisanextremelyrarebuthighlyaggressivetumorwithlimitedinformationregardingsurvivalandprog

2、nostlcfactorsInordertoidentifyprognosticpredictorsofsurvivalandimprovetreatmentselection，weperformedthisretrospectivestudyMaterialsandMethods：BetweenDecember2002andAugust2011，forty。fourDatientswithhistologicallydiagnosed

3、PMMVinFudanUniversityShanghaiCaneerCenterwereevaluatedretrospectivelyPrognosticvariableswereanalyzedbybothKaplanMeiersurvivalanalysisandCoxproportionalhazardsregresslonResuIts：Themeanageofthepatientswas587years，andsevent

4、y。seVenpercentofpatientswerepostmenopausalwomenOfthe44patients，forty。oneweretreatedwlthsurgeryand3withradiochemotherapyonlyThemeanfollow’uptimewas276moms(range，30943months)Thirty(682呦ofthe44patientsdevelopedrecurrences，棚

5、1d21(477％)patientsdiedofdiseaseThe2yearprogression一打eesuⅣivalrateandoverallsurvivalratewere384％and614％，respectivelyThe5。Ye甜progressionfreesurvivalrateandoverallsurvivalratewere183％and398％，respe曲elyMedianprogressionfreesu

6、rvivaltimewas144months(95％co曲denceinter、ral[CI】：98189months)andmedianoverallsurvivaltimewas395monthsf95％CI94697months)Onunivariateanalysis，depthofinvasionwa8animportantprognosticpredictorforoverallsurvival(P=0004)Andaaju

7、Vanttherapy啪sstatisticallyassociatiedwitprogression—freesurvival(P20038)Onmultivariableanalvsis，depthofinvasionwasanindependentprognosticpredictorforovera上lsurvivalfP=0041)andtumorsizeandadjuvanttherapywereindependentpro

8、口ostlcDredictorforPFS(P=0003，P=0005，respectively)Age，menopausalstatus，multifocallesion，theextentofsurgerylymphnodestatusandpositivemarginwereall110tstatisticallysignificantassociatedwithPFSandOS，thoughlymphnodestatusandD

9、ositivemarginmayhavesometendencyespeciallythelymphnodestatusAndtherewaSanobviousstatisticalassociationbetweendepthofinvasionandlymphnodestatus(P=0048)Conelusion：Primarymalignantmelanomaofthevaginaisarare，highlylethaldise

10、aseOptimaltreatmentshouldbeconsideredassurgeryinfavoroflocalwideexcisionforsuitablewomenTheprognosisisdeeplyinfluencedbytumordepthofinvasionandlymphnodesinvolvementTumorsizeandadjuvanttherapywasassociatedwithprogression—