| ObjectiveTo investigate the effect of clinical staging,resection range,ulcer and thickness on postoperative survival rate of acral lentiginous melanoma,and to research the clinical effect of sentinel lymph node biopsy and regional lymph node dissection,and provide the clinical thought for retaining functions,postponing the relapse and increasing survival ratio.Materials and MethodsWe collect the clinical data of 88 patients with acral lentiginous melanoma from January 2013 to March 2018,including 48 males and 40 females.The patients are 25 to 91 years old,with an average age of 60.5 years,and the course of the disease range from 2 months to 50 years.Primary lesions are located in the foot include 57 patients,and the others are located in the hand.All the patients have completed preoperative examination,have surgical indications and receive surgical treatment,and all the pathologies are acral lentiginous melanoma.Sentinel lymph node biopsy is performed in 30 patients,negative in 26 patients and positive in 4 patients.According to the AJCC version 8 clinical staging,?-staged there are 18 patients,?-staged 46 patients,?-staged 24 patients.According to the clinical stages are divided into three groups:?-staged,?-staged,?-staged.According to the scope of operation is divided into two groups: amputation group and limb salvage group.According to the result of pathology is divided into ulcer group and no ulcer group.According to the thickness of the tumor is divided into the group with thickness ?1.0mm,the group with thickness 1.01 ~ 4mm and the group with thickness > 4mm.According to SLNB is divided into the sentinel lymph node biopsy group and non-sentinel lymph node biopsy.According to the lymph node dissection is divided into lymph node dissection group and non-lymph node dissection group.SPSS is used for statistical analysis on the differences in the effects of gender,clinical stage,the scope of operation,ulcer,tumor thickness,sentinel lymph node biopsy and lymph node dissection on survival rate and recurrence rate of 83 patients who were effectively followed up.ResultsAmong the 88 patients,5 patients are lost to follow-up,and 83 patients are effectively followed up,with a follow-up rate of 94.3%.The follow-up time range from 7 months to 64 months,and the median follow-up time is 54 months.The median survival time of 48 male patients is 54 months,while that of 40 female patients is not obtained,and there is no statistically significant difference.?don't get the median survival time of ?-staged patients,with the survival rate of 1 year,2 years,3 years are 100%,94.1% and 94.1% respectively.The median survival time of ?-staged patients is 54 months,with the survival rate of 1 year,2 years,3 years are 97.8%,93.2% and 74.7% respectively.The median survival time of ?-staged patients is 30 months,with the survival rate of 1 year,2 years,3 years are 83.3%,52.9% and 37.1% respectively.There are statistically significant differences among the three groups(P < 0.05).The median survival time of amputees is 59 months,and that of limb salvage patients is 54 months.There is no statistically significant difference among the two groups.The median survival time of those with ulcer is 44 months,while that of those without ulcers is not obtained.There is no statistically significant difference among the two groups.Median survival time is not obtained in patients with primary tumor thickness of 1.0mm.The median survival time of patients with thickness of 1.01 ~ 4mm is more than 47 months.The median survival time of patients with tumor thickness of > 4mm is more than 35 months.There is no statistically significant difference among the three groups.Sentinel lymph node biopsy is performed in 30 patients,and recurrence is found in 5 patients.There are 37 patients in the non-sentinel lymph node group and 17 patients with recurrence.The recurrence rate of the two groups is tested by chi-square test with SPSS(P<0.05).There are statistically significant differences among the two groups.Regional lymph node dissection is performed in 18 patients and 9 patients are surviving.There are 8 patients in the group without lymph node dissection and 1 patient is surviving.The survival rate of the two groups is tested by Fisher's exact probability method with SPSS(P>0.05).There is no statistically significant difference among the two groups.Conclusion1.There is a worse prognosis in the case of advanced stage.The key to improving prognosis is early diagnosis and treatment.2.Amputation cannot improve the survival of acral lentiginous melanoma,and the limbs function should be remained as far as possible to improve the quality of life under the condition that the range of resection is sufficient.3.Sentinel lymph node biopsy can detect metastasis at an early stage,reduce the risk of relapse of acral lentiginous melanoma,and provide clinical evidence for regional lymph node dissection.4.Regional lymph node dissection can slow down metastasis,whether it can improve survival rate need to be studied. |
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