A Case Series of Anorectal Melanoma in a Single Institution

肛門直腸黑色素癌單一機構病例分析

許毓倫(Yu-Lun Hsu) ； 林春吉(Chun-Chi Lin) ； 藍苑慈(Yuan-Tzu Lan) ； 王煥昇(Huann-Sheng Wang) ； 張世慶(Shih-Ching Chang) ； 楊純豪(Shung-Haur Yang) ； 陳維熊(Wei-Shone Chen) ； 林資琛(Tzu-Chen Lin) ； 林楨國(Jen-Kou Lin) ； 姜正愷(Jeng-Kae Jiang) ； 林宏鑫(Hung-Hsin Lin)

《中華民國大腸直腸外科醫學會雜誌》 30卷4期 (2019/12) Pp. 181-186

https://doi.org/10.6312/SCRSTW.201912_30(4).10813

摘要

Purpose. Anorectal melanoma is a rare but aggressive disease comprising approximately 1%-2% of all melanomas. Several case series in Western countries reported about this disease. This study aimed to analyze the symptoms, treatment, and survival of patients with anorectal melanoma in a single center in Taiwan. Methods. All patients diagnosed with anorectal melanoma in Taipei Veterans General Hospital from 1998 to 2017 were included. We collected data on patient characteristics, symptoms, disease stage, treatment, and overall survival. Results. Eighteen patients were enrolled, including 6 with anal melanoma and 12 with rectal melanoma. The mean age was 61.8 years at diagnosis. Eight patients (44.4%) were male. The symptoms included bleeding during defecation (72%), bowel habit change (44%), anal pain (22%), pruritus (11%), and anorectal prolapse (11%). At diagnosis, 4 patients had local disease only described as stage I, 5 patients had regional lymph nodes described as stage II, and 9 patients had distal metastasis described as stage III. Fourteen patients underwent surgery, including local excision (n = 6, 33.3%) and abdominal perineal resection (n = 8, 44.4%). Patients with stage III disease had poorer overall survival than those with stage I and II diseases. In stage I and II diseases, there was no disease-free (p = 0.48) or overall survival (p = 0.72) benefit between local excision and abdominoperineal resection. Conclusions. Anorectal melanoma is an aggressive disease with rapid local recurrence or distal metastasis even after radical resection, chemotherapy, radiotherapy or immunotherapy. Further study about the ideal multimodality therapy may be needed to improve the outcome of this aggressive disease.

關鍵字

Anorectal melanoma ； Surgery ； Survival

並列摘要

主旨：肛門直腸黑色素癌是一個罕見卻非常惡性的疾病，1-2%的黑色素癌發生在肛門直腸，有許多西方國家針對此疾病做過案例統計，此篇研究主要分析近20年台灣單一醫療機構的肛門直腸黑色素癌的案例分析。方法：我們從台北榮民總醫院的病理資料庫蒐集自1998至2017所有的肛門直腸黑色素癌的病患資料，其中包含病人基本資料、症狀、初始的分期、初步治療以及預後。結果：一共有18位肛門直腸黑色素癌病人。6位之腫瘤長在肛門而12位於直腸，平均發病年齡於61歲，女性的比例高於男性（55.6% vs. 44.4%），大部分的病人症狀包含血便、排便習慣改變、肛門疼痛、搔癢或肛門異物脫垂。其中有4位疾病診斷時為第一期，5位為第二期，這兩期平均存活時間約20個月。但有一半的病人（9位）於診斷時已經是第三期且其平均存活時間只剩7個月。肺部以及肝臟為最常見之轉移器官。一共有14位病人接受手術治療，包含了6位接受局部切除以及8位接受腹部會陰聯合切除。但對於第一、二期的病人，接受局部切除或腹部會陰聯合切除對於其預後存活或腫瘤局部控制並沒有達到顯著的差異。結論：肛門直腸黑色素癌仍是一非常惡性且致命的疾病，廣泛的手術切除或局部切除對預後並沒有太大的影響，我們需要針對此疾病有更深入的了解。

並列關鍵字

肛門直腸黑色素癌 ； 手術治療 ； 存活

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