恶性黑色素瘤患者的预后及影响因素研究

doi:10.12114/j.issn.1007-9572.2023.0307

中国全科医学 ›› 2024, Vol. 27 ›› Issue (08): 942-947.DOI: 10.12114/j.issn.1007-9572.2023.0307

恶性黑色素瘤患者的预后及影响因素研究

武淑琴¹^,², 王远涵², 郑凯元³, 韩红娟¹^,², 康金秀⁴^,^*(), 余红梅²^,^*()

1．030001　山西省太原市，山西医科大学基础医学院数学教研室
2．030001　山西省太原市，山西医科大学公共卫生学院卫生统计学教研室
3．030001　山西省太原市，山西医科大学第一医院
4．030001　山西省太原市，山西省肿瘤医院宁养医院

收稿日期:2023-05-22 修回日期:2023-07-19 出版日期:2024-03-15 发布日期:2023-12-19
通讯作者: 康金秀, 余红梅
作者贡献：武淑琴提出主要研究目标，负责研究的构思与设计，研究的实施，撰写论文；王远涵负责起草论文及最终版修订；余红梅负责统计学方法指导；王远涵、郑凯元、韩红娟进行数据收集，以及图、表的绘制；康金秀、余红梅负责文章质量控制与审查，对文章整体负责，监督管理。
基金资助:
国家自然科学基金面上项目(82273742)

Prognosis and Influencing Factors of Patients with Malignant Melanoma

WU Shuqin¹^,², WANG Yuanhan², ZHENG Kaiyuan³, HAN Hongjuan¹^,², KANG Jinxiu⁴^,^*(), YU Hongmei²^,^*()

1. Department of Mathematics, School of Basic Medicine, Shanxi Medical University, Taiyuan 030001, China
2. Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
3. First Hospital of Shanxi Medical University, Taiyuan 030001, China
4. Shanxi Cancer Hospital Hospice, Taiyuan 030001, China

Received:2023-05-22 Revised:2023-07-19 Published:2024-03-15 Online:2023-12-19
Contact: KANG Jinxiu, YU Hongmei

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摘要/Abstract

摘要： 背景恶性黑色素瘤（MM）由表皮黑色素细胞恶性变而成，恶性程度极高，其防治是皮肤病领域的重点课题。目的探讨MM患者的预后情况及其影响因素。方法选取2006—2021年山西医科大学附属第一医院收治的205例肢端MM患者为研究对象。通过收集患者电子病历信息获得临床资料，以电话随访方式确认患者总生存期（OS），随访截至2022-12-31。采用Kaplan-Meier法绘制MM患者OS的生存曲线，不同影响因素的生存曲线比较采用Log-rank检验。采用多因素Cox比例风险回归模型分析MM患者生存结局的影响因素。结果 MM患者1年、3年和5年总生存率分别为94.6%（194/205）、81.9%（168/205）、72.6%（149/205），患者平均OS为71.77个月，中位生存期为66.83个月。不同性别、年龄、肿瘤厚度、瘤体溃疡、淋巴结转移、中性粒细胞与淋巴细胞比值（NLR）的MM患者OS比较，差异有统计学意义（P<0.05）。多因素Cox比例风险回归分析结果显示，男性（HR=1.644，95%CI=1.148~2.498）、肿瘤厚度>1.94 mm（HR=2.466，95%CI=1.419~4.284）、瘤体溃疡（HR=1.821，95%CI=1.225~2.708）、淋巴结转移（HR=1.999，95%CI=1.305~2.892）、NLR≥3（HR=1.873，95%CI=1.108~3.166）是MM患者生存结局的影响因素（P<0.05）。结论男性、肿瘤厚度>1.94 mm、瘤体溃疡、淋巴结转移、NLR≥3为影响MM患者不良预后的因素。医务工作者可以重点关注有以上不良预后因素的MM患者，加强护理提高其生存率，从而更好地指导临床。

关键词: 恶性黑色素瘤, 预后, Cox模型, 列线图, 总生存期, 影响因素分析, 山西省

Abstract:

Background

Malignant melanoma (MM) is caused by the malignant transformation of epidermal melanocytes with extremely high malignant degree, and its prevention and treatment is a key issue in the field of dermatology.

Objective

To investigate the prognosis of patients with MM, and influencing factors of the prognosis of patients with MM.

Methods

A total of 205 patients with malignant melanoma from the First Affiliated Hospital of Shanxi Medical University from January 2006 to December 2021 were selected as the subjects. The clinical data were obtained by collecting information from electronic medical records of patients, the overall survival (OS) was confirmed by telephone follow-up, and the last follow-up visit until 2022-12-31. The survival curve was plotted by the Kaplan-Meier method, and Log-rank test was used to compare the survival curves of different influencing factors. Multivariate Cox proportional hazard regression model was used to analyze the influencing factors of survival outcome in MM patients.

Results

The 1-year overall survival, 3-year overall survival, and 5-year overall survival rates of MM patients were 94.6% (194/205) , 81.9% (168/205) and 72.6% (149/205) , respectively, the mean OS was 71.77 months and the median OS was 66.83 months. The results of survival curve analysis showed statistically significant differences when comparing the OS of MM patients with different genders, ages, tumor thicknesses, tumor ulcers, lymph node metastases, and neutrophil-to-lymphocyte ratios (NLR) (P<0.05) . Multivariate Cox regression analysis showed that male (HR=1.644, 95%CI=1.148-2.498) , tumor thickness >1.94 mm (HR=2.466, 95%CI=1.419-4.284) , tumor ulcer (HR=1.821, 95%CI=1.225-2.708) , lymph node metastasis (HR=1.999, 95%CI=1.305-2.892) , and NLR≥3 (HR=1.873, 95%CI=1.108-3.166) were the influencing factors of survival outcome in MM patients (P<0.05) .

Conclusion

Male, tumor thickness >1.94 mm, tumor ulcer, lymph node metastasis and NLR≥3 are poor prognostic factors for MM patients. Medical workers can focus on MM patients with the above poor prognostic factors and enhance care to improve their survival rate, thus better guiding the clinic treatment.

Key words: Malignant melanomas, Prognosis, Cox models, Nomograms, Overall survival, Root cause analysis, Shanxi province

武淑琴,王远涵,郑凯元,等. 恶性黑色素瘤患者的预后及影响因素研究[J]. 中国全科医学, 2024, 27(08): 942-947. DOI: 10.12114/j.issn.1007-9572.2023.0307.
WU Shuqin,WANG Yuanhan,ZHENG Kaiyuan, et al. Prognosis and Influencing Factors of Patients with Malignant Melanoma[J]. Chinese General Practice, 2024, 27(08): 942-947. DOI: 10.12114/j.issn.1007-9572.2023.0307.

图/表 10

图1 MM患者OS的Kaplan-Meier生存曲线注：OS=总生存期。

Figure 1 Kaplan-Meier survival curve for OS in MM patients

图2 不同性别MM患者OS的Kaplan-Meier生存曲线

Figure 2 Kaplan-Meier survival curves for OS in MM patients of different genders

图3 不同年龄MM患者OS的Kaplan-Meier生存曲线

Figure 3 Kaplan-Meier survival curves for OS in MM patients of different ages

图4 不同肿瘤厚度MM患者OS的Kaplan-Meier生存曲线

Figure 4 Kaplan-Meier survival curves for OS in MM patients of different tumor thicknesses

图5 不同瘤体溃疡MM患者OS的Kaplan-Meier生存曲线

Figure 5 Kaplan-Meier survival curves for OS in MM patients of different tumor ulcers

图6 不同淋巴结转移MM患者OS的Kaplan-Meier生存曲线

Figure 6 Kaplan-Meier survival curves for OS in MM patients of different lymph node metastases

图7 不同NLR MM患者OS的Kaplan-Meier生存曲线注：NLR=中性粒细胞与淋巴细胞比值。

Figure 7 Kaplan-Meier survival curves for OS in MM patients of different NLR

表1 MM患者生存结局影响因素的多因素Cox比例风险回归分析赋值表

Table 1 Assignment table for multivariate Cox proportional hazard regression analysis of influencing factors of survival outcome in MM patients

变量	赋值
生存结局	死亡=1，生存=2
性别	女=0，男=1
年龄	≤50岁=1，>50岁=2
肿瘤厚度	≤1.94 mm=1，>1.94 mm=2
瘤体溃疡	无=0，有=1
淋巴结转移	无=0，有=1
NLR	<3=0，≥3=1

表2 MM患者生存结局影响因素的多因素Cox比例风险回归分析

Table 2 Multivariate Cox proportional hazard regression analysis of the influencing factors of survival outcome in MM patients

变量	β	SE	Wald χ²值	P值	HR值	95%CI
男性	0.527	0.199	2.654	0.010	1.644	1.148~2.498
年龄>50岁	0.371	0.193	1.924	0.055	1.450	0.993~2.116
肿瘤厚度>1.94 mm	0.903	0.282	10.259	0.001	2.466	1.419~4.284
瘤体溃疡	1.053	0.336	2.961	0.002	1.821	1.225~2.708
淋巴结转移	0.664	0.203	3.270	<0.001	1.999	1.305~2.892
NLR≥3	0.627	0.268	5.484	0.019	1.873	1.108~3.166

图8 MM患者生存结局影响因素的多因素Cox比例风险回归模型列线图

Figure 8 Cox proportional hazard regression model nomogram of the influencing factors of survival outcome in MM patients

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恶性黑色素瘤患者的预后及影响因素研究

Prognosis and Influencing Factors of Patients with Malignant Melanoma

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