The Clinical Observation Of Highdose Interferon α-2b On Adjuvant Therapy And Prognosis Analysis Of Acral Melanoma Patients

Background: With the increasingly morbidity of malignant melanoma, acral melanoma, as the most common sub-type melanoma in Asians, becomes not rare anymore. However, the researches of adjuvant therapy and prognostic factors of acral melanoma remain to be improved.Objective: To analyze the efficacy and safety of acral melanoma patients to high--dose Interferon α-2b adjuvant therapy intravenously. And explore the prognostic risk factors by analyzing the clinical data from patients with acral melanoma retrospectively.Methods: The clinical data of 43 acral melanoma cases from August 2008 to June 2013 in First Affiliated Hospital of Dalian Medical University were analyzed retrospectively. All of these 43 patients were resectable, 19 of whom were undergone high--dose Interferon α-2b adjuvant therapy. We analyzed the correlation of high--dose Interferon α-2b adjuvant therapy and relapse-free survival as well as observed the toxicity of patients in treatment group to evaluate tolerance. We explored the prognostic risk factors including age, gender, smoking, primary site, whether there is a history of trauma or ulceration, the acceptability of lymph node dissection and status of regional lymph nodes, and time from onset to treatment by Kaplan-Meier survival analysis and Cox regression multivariate analysis.Results: 1. Majority of 43 patients were male(60.5%) with the median age of 63 year-old. The major patients were female with the median age of 62 years old. Primary site of 20 patients appeared in vola(46.5%),as the most common site, followed by 13 cases showed in subungual(30.3%).2. Relapse-free survival between patients in treatment group and non-treatment group was statistically significant(P=0.001)with the prolongation of median RFS in treatment group notably(26 months vs.12 months).The severe adverse events of patients in treatment group were neutropenia, observed in 5 cases(26.3%),fever、vomiting and fatigue, both of which were observed in 2 cases(10.5%). Severe hepatoxicity was observed in only 1 patient(5.3%).3. Presence of ulceration(P=0.008),regional lymphatic metastasis(P=0.015)and primary site(P=0.023)were significantly associated with acral melanoma clinical outcome in terms of RFS. The COX regression demonstrated the ulceration(P=0.000), regional lymphatic metastasis(P=0.043)and primary site(P=0.021)were the independent poorly prognostic indicators.Conclusion: 1. High--dose Interferon α-2b adjuvant therapy significantly prolong the RFS of patients.2. The toxicity of high--dose Interferon α-2b were tolerable by most patients. Patients reached to the maximum dose of high--dose Interferon α-2b therapy gradually and received rational pretreatment were contribute to improve the tolerance.3. Presence of ulceration and regional lymphatic metastasis are prognostic factor to predict wither RFS of acral melanoma.4. Different primary site of malignant melanoma shows different prognosis and subungual is the subtype with the longest RFS.