Analysis Of Risk Factors For Postoperative Recurrence Of Extremal Malignant Melanoma

Background and purposeMalignant melanoma(MM)is formed by the Malignant transformation of melanocytes in the basal layer of epidermis.Among Asians,acral melanoma(AM)account for 50% of the total number of MM.Since there are many factors influencing the recurrence of AM after operation,these factors have become the main factors influencing the survival time of these patients.Therefore,this study aims to explore the recurrence of AM after operation and its related risk factors,to provide more theoretical basis for prevention of recurrence,better guidance of individualized treatment after surgery,to extend the survival of patients.MethodThe clinical data of 273 patients with AM admitted to the Harbin Medical University from January 01,2013 to January 01,2015 were collected.All patients had a definite pathological diagnosis.all patients achieved R0 after operation.Patients were recorded for recurrence-related conditions.All patients were divided into three groups according to their clinical stages: Stage Ⅰ group,Stage Ⅱ group and Stage Ⅲ group,to analyze the influence of tumor thickness,tumor ulcer,age at first diagnosis,pathological classification and sex on postoperative recurrence of AM in stage Ⅰ and Ⅱ patients.The influence of tumor thickness,tumor ulcer,age at first diagnosis,pathological classification,sex,regional lymph node metastasis,postoperative adjuvant therapy and LDH on the recurrence of AM was analyzed.Univariate analysis was performed by chi-square test,while multivariate analysis was performed by Cox Regression analysis.ResultAs of January 01,2020,273 patients were completely followed up.132 patients had postoperative recurrence.The 3-year total recurrence rate was 48.35%.Among them,146 male patients were 53.48%,127 female patients were 46.52%,the ratio of male to female was 1:1.15.The age of first visit ranged from 24 to 82 years,and the mean age of first visit was 50.12 to 14.16 years.Among them,Among them,39 cases(29.1%)had recurrence in situ,43 cases(32.5%)had metastasis to the lung,20 cases(15.4%)to the brain,16 cases(12.2%)to the liver,8 cases(6.1%)to the bone and 6cases(4.7%)to other parts of the body.There were 40 patients in stage Ⅰ group,80 patients in Stage Ⅱ group,153 patients in Stage Ⅲ group,and 14.65%,29.30% and56.04% of patients in stage Ⅰ,Ⅱ and Ⅲ groups respectively.Median disease-free survival was 27.5 months in women and 25 months in men with Stage Ⅲ disease-free survival was 30.5 months in patients younger than 60 years of age > 21 months in patients younger than 60 years of age median disease-free survival was 19.5 months in patients with primary lesions and ulcers,the disease-free survival time was 55.5months in patients with tumor thickness ≤1mm,22 months in patients with tumor thickness between 1mm and 4mm,and 17 months in patients with tumor thickness >4mm.The median disease-free survival time was 26 months in patients with superficial diffusion and 8 months in patients with nodular type,the median disease-free survival time with regional lymph node metastasis was 20 months,the median disease-free survival time with post-operative adjuvant therapy was 39.5months,the median disease-free survival time was 23 months,the elevation of LDH was 30.5 months,the elevation of LDH was 11 months.Univariate analysis showed that age at first diagnosis,tumor thickness,tumor ulcer and tumor classification in Stage Ⅰ and Ⅱ patients;Age At initial diagnosis,tumor thickness,tumor ulcer,tumor classification,postoperative adjuvant therapy,regional lymph node metastasis,LDH and other factors were associated with postoperative recurrence of AM.Multivariate Cox Regression analysis showed: Tumor thickness,tumor ulcer and tumor classification in Stage Ⅰ and Ⅱ patients;Tumor thickness,tumor ulcer,tumor classification and adjuvant therapy were independent risk factors for postoperative recurrence of AM in Stage Ⅲ patients.ConclusionThe age at first diagnosis,tumor ulcer,tumor thickness and tumor type of AM patients were correlated with postoperative recurrence.POSTOPERATIVE recurrence in Stage Ⅲ patients was associated with adjuvant therapy,regional lymph node metastasis,and LDH.Tumor Ulcer,tumor thickness and tumor type were independent risk factors for postoperative recurrence of AM,the Independent risk factors for postoperative recurrence in patients with stage Ⅲ AM also included the presence or absence of postoperative adjuvant therapy.