| Objective(s): In this study,relevant clinical characteristics of female patients with malignant melanoma of reproductive tract admitted to Yunnan Cancer Hospital from 2005 to 2022 were collected to determine the recurrence rate,treatment methods,factors affecting recurrence and prognosis,survival rate differences of patients and efficacy evaluation of patients receiving immunotherapy.To provide more clinical data for the study of rare diseases such as female genital melanoma,and provide guidance for gynecologists to make reasonable treatment plans for these patients in the future.Methods: In this study,the basic information and related clinical information of patients with melanoma of the female reproductive tract diagnosed in our hospital from October 2005 to July 2022 were collected.The data were analyzed by IBMSPSSversion26.0 software.The factors related to survival rate and treatment were analyzed by a Log-rank test.Cox proportional hazard model was used to analyze the factors affecting recurrence and prognosis.Results:1 Basic characteristics and survival rateIn this study,46 cases were included,23 from the vulva,19 from the vagina,and4 from the cervix.No patients with primary malignant melanoma of the ovary and uterine body were found during the study period.The median DFS and median OS of46 patients with melanoma of the female reproductive tract were 8.86 months and57.3 months respectively.The recurrence rate was 32 prime 46(69.6%),and the mortality rate was 17 prime 46(37.0%).The 5-year cumulative disease-free survival rate was 19.1%.The 5-year cumulative survival rate was 49.7%.2 DFS and OS analysis of patients with genital melanoma in different sites and stagesThe recurrence rate of 23 patients with vulvar melanoma was 15/23(65.2%),and the mortality rate was 10/23(43.5%).The recurrence rate of 23 patients with vaginal cervical melanoma was 17/23(73.9%),and the mortality rate was 3/19(30.4%).The median DFS of vulvar melanoma was significantly longer than that of vaginal and cervical melanoma,and the difference was statistically significant(29.85 months vs4.5 months,p=0.021),but there was no significant difference in OS(78.5 months,vs29.5 months,p=0.152).The median OS was significantly longer in stage I than in stage III/IV in vulvar melanoma and the difference was statistically significant(78.5months vs 15.0 months,p=0.001);in vaginal melanoma: The median DFS was shorter in FIGO stage I than in stage III and the difference was not statistically significant(4.5 months vs 8.2 months,p=0.472).3 The DFS and OS of patients with different treatment methods were analyzed.3.1 Treatment and survival of vulvar melanoma.In vulvar melanoma,the median DFS of the local resection group was shorter than that of the radical resection group(6.0 months vs 36.0 months,p=0.191),and there was no significant difference in median DFS or median OS between the two groups(82.0 months vs 78.5 months,p=0.526).The median DFS(33.8 months vs36.0 months,p=0.645)and OS(82.0 months vs 78.5 months,p=0.318)of patients with stage Ⅰ / Ⅱ vulvar melanoma were not significantly different between the two groups.In vulvar melanoma,the median DFS of the non-adjuvant therapy group was significantly lower than that of the adjuvant therapy group(5.3 months vs 50.9months,p=0.003).The median OS of the non-adjuvant therapy group was not reached,and the median OS of the adjuvant therapy group was 78.5 months,the difference was not statistically significant.The median DFS and OS of the interferon group were longer than those of the chemotherapy group,but there was no significant difference between them.3.2 Treatment and survival of vaginal melanomaIn 19 cases of vaginal melanoma,the median DFS of the unoperated group was longer than that of the surgical group,and the difference was not statistically significant(8.2 months vs 4.5 months,p=0.216).The median OS time could not be calculated because of the large amount of censored data in the two groups.The median DFS and OS of the local resection group were shorter than those of the radical resection group(4.5 months vs 11.0 months,p=0.073;23.6 months vs 29.5 months,p=0.695),there was no significant difference.The median DFS of the uncleaned group was longer than that of the clean group(8.86 months vs 3.2 months,p=0.321).The median OS of the uncleaned group was not reached,and the median OS of the clean group was 29.5 months.There was no significant difference between the two groups.Of the 13 cases of vaginal melanoma treated by operation,12 cases were treated with adjuvant therapy,including 1 case in the interferon group(X42)and 11 cases in the chemotherapy group.The DFS and OS of interferon therapy were 8.86 months and 12.5 months respectively.The median DFS of the chemotherapy group was 4.5 months(range 2 months ～30.5 months,95% confidence interval 0～9.355).Because there were only 2 cases of final events,it was impossible to effectively calculate the median OS(range 3.6 months ～ 57.6 months).3.3 Treatment of advanced melanoma of the female reproductive tract with PD-1 monoclonal antibodyAmong the patients with advanced melanoma of the reproductive tract,6 patients were not treated with PD-1 monoclonal antibody and 4 patients were treated with PD-1 monoclonal antibody.The median DFS of the PD-1 monoclonal antibody treatment group was longer than that of the non-PD-1 monoclonal antibody treatment group,and the difference was not statistically significant(8.2 months vs 3.5 months,p=0.063).The median OS of the group without PD-1 monoclonal antibody treatment was 8.5 months,and the median OS of the PD-1 monoclonal antibody treatment group was not significantly different,p=0.320.3.4 Survival of patients after recurrence or progressionIn 32 patients with recurrent female genital tract melanoma,the median post-recurrence OS was longer than in the distant metastasis group and the both group,but the differences between the three groups were not statistically significant(42.5months vs 9.7 months vs 4.8 months,p=0.303).The median recurrent OS of the vulva group was longer than that of the vaginal cervix group,and there was no significant difference between the vulva group and vaginal cervix group(14.2 months vs 9.1months,p=0.516).In 28 patients with recurrent vulvovaginal melanoma,the median OS after recurrence in the continued treatment group was significantly longer than that in the abandoned group,and the difference was statistically significant.(42.5months vs 4.8 months,p=0.006).4 Factors affecting the recurrence and prognosis of female genital melanomaTumor location(vagina),no adjuvant therapy after the operation,and large thickness of Breslow were independent risk factors for the recurrence of female melanoma.Imaging findings suggest that metastasis is a risk factor for the prognosis of patients with melanoma of the female reproductive tract.Conclusion(s):1.The recurrence rate of female genital tract melanoma is high,and the rate of distant metastasis is significantly higher than that of local recurrence.The post-relapse OS of patients with distant metastasis is significantly lower than that of patients with local recurrence.Continued treatment after recurrence can prolong the survival of patients;2.The tumor location(vagina),no postoperative adjuvant treatment,and Breslow thickness are independent risk factors for recurrence of female genital melanoma,and "imaging suggests metastasis" is a risk factor affecting the prognosis of female genital melanoma;3.The disease-free survival of vulvar melanoma is significantly longer than that of vaginal and cervical melanoma,and patients with stage Ⅰ/Ⅱ vulvar melanoma can benefit from local tumor resection with adjuvant therapy;4.Patients with early vaginal melanoma benefit more from radical surgery plus adjuvant therapy(PD-1 monoclonal antibody);5.The immunotherapy(PD-1 monoclonal antibody)has initially shown good therapeutic prospects in stage III and IV genital tract melanoma. |
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