Abstract：
OBJECTIVE: To evaluate recurrence patterns and survival after recurrence among patients with sinonasal mucosal melanoma (SNMM).
METHODS: This was a multi-institutional retrospective review from seven U.S. institutions of patients with SNMM from 1991 to 2022. Recurrence was categorized as local, regional, distant, or multifocal. Kaplan-Meier tests were used to evaluate disease-free survival (DFS), overall survival (OS), and post-recurrence survival (PRS) reported with standard errors (SE) and log-rank testing used for comparison. Cox-regression was further used, with hazard ratios (HR) and 95% confidence intervals (CI) reported.
RESULTS: Among 196 patients with SNMM, there were 146 patients with recurrence (74.5%). Among all patients, 60-month DFS (SE) was 15.5% (2.9%), 60-month OS (SE) was 44.7% (3.7%), mean age ± standard deviation at diagnosis was 69.7 ± 12.5 years, and 54.6% were female. In 26 patients who underwent primary treatment of the neck, 60-month DFS did not differ from no treatment (p > 0.05). Isolated distant recurrence was most common (42.8%), followed by local (28.3%), multifocal (20.7%), and regional recurrence (8.3%). Among patients with regional recurrence in the neck, there was no 60-month PRS benefit for patients undergoing salvage neck dissection or radiation (p > 0.05). Among patients with distant recurrence, only immunotherapy was associated with improved 12-month PRS (HR = 0.32, 95% CI = 0.11-0.92, p = 0.034), and no treatment group was associated with improved 24- or 60-month PRS (p > 0.05).
CONCLUSIONS: SNMM is associated with a high recurrence rate and poor survival. Primary treatment of the neck was not associated with reduced recurrence, and immunotherapy for treatment of distant recurrence was associated with increased 12-month PRS.
METHODS: This was a multi-institutional retrospective review from seven U.S. institutions of patients with SNMM from 1991 to 2022. Recurrence was categorized as local, regional, distant, or multifocal. Kaplan-Meier tests were used to evaluate disease-free survival (DFS), overall survival (OS), and post-recurrence survival (PRS) reported with standard errors (SE) and log-rank testing used for comparison. Cox-regression was further used, with hazard ratios (HR) and 95% confidence intervals (CI) reported.
RESULTS: Among 196 patients with SNMM, there were 146 patients with recurrence (74.5%). Among all patients, 60-month DFS (SE) was 15.5% (2.9%), 60-month OS (SE) was 44.7% (3.7%), mean age ± standard deviation at diagnosis was 69.7 ± 12.5 years, and 54.6% were female. In 26 patients who underwent primary treatment of the neck, 60-month DFS did not differ from no treatment (p > 0.05). Isolated distant recurrence was most common (42.8%), followed by local (28.3%), multifocal (20.7%), and regional recurrence (8.3%). Among patients with regional recurrence in the neck, there was no 60-month PRS benefit for patients undergoing salvage neck dissection or radiation (p > 0.05). Among patients with distant recurrence, only immunotherapy was associated with improved 12-month PRS (HR = 0.32, 95% CI = 0.11-0.92, p = 0.034), and no treatment group was associated with improved 24- or 60-month PRS (p > 0.05).
CONCLUSIONS: SNMM is associated with a high recurrence rate and poor survival. Primary treatment of the neck was not associated with reduced recurrence, and immunotherapy for treatment of distant recurrence was associated with increased 12-month PRS.
摘要：
目的：评估鼻腔鼻窦粘膜黑色素瘤（SNMM）患者的复发模式和复发后的生存率。
方法：美国7个机构1991-2022年SNMM患者的多机构回顾性研究。复发被归类为本地，区域,遥远,或多焦点。Kaplan-Meier检验用于评估无病生存率（DFS），总生存期（OS），和复发后生存率（PRS），报告标准误差[SE]，并使用对数秩检验进行比较。进一步使用Cox回归，报告了风险比(HR)和95%置信区间(CIs)。
结果：在196名SNMM患者中，有146例患者复发(74.5%).在所有患者中，60个月DFS为15.5%[2.9%]，60个月OS为44.7%[3.7%]，诊断时的平均年龄±标准差为69.7±12.5岁，54.6%为女性。在26例接受颈部初级治疗的患者中，60个月DFS与未治疗无差异(p>0.05)。孤立的远处复发是最常见的（42.8％），其次是本地(28.3%)，多焦（20.7%），和区域性复发(8.3%)。在颈部局部复发的患者中，接受挽救性颈部夹层或放疗的患者没有60个月的PRS获益(p>0.05)。在远处复发的患者中，仅使用免疫疗法与改善的12个月PRS相关（HR=0.32，95％CI=0.11-0.92，p=0.034），无治疗组24个月或60个月PRS改善(p>0.05)。
结论：SNMM与高复发率和低生存率相关。颈部的主要治疗与减少复发无关。治疗远处复发的免疫治疗与12个月PRS增加相关。本文受版权保护。保留所有权利。
方法：美国7个机构1991-2022年SNMM患者的多机构回顾性研究。复发被归类为本地，区域,遥远,或多焦点。Kaplan-Meier检验用于评估无病生存率（DFS），总生存期（OS），和复发后生存率（PRS），报告标准误差[SE]，并使用对数秩检验进行比较。进一步使用Cox回归，报告了风险比(HR)和95%置信区间(CIs)。
结果：在196名SNMM患者中，有146例患者复发(74.5%).在所有患者中，60个月DFS为15.5%[2.9%]，60个月OS为44.7%[3.7%]，诊断时的平均年龄±标准差为69.7±12.5岁，54.6%为女性。在26例接受颈部初级治疗的患者中，60个月DFS与未治疗无差异(p>0.05)。孤立的远处复发是最常见的（42.8％），其次是本地(28.3%)，多焦（20.7%），和区域性复发(8.3%)。在颈部局部复发的患者中，接受挽救性颈部夹层或放疗的患者没有60个月的PRS获益(p>0.05)。在远处复发的患者中，仅使用免疫疗法与改善的12个月PRS相关（HR=0.32，95％CI=0.11-0.92，p=0.034），无治疗组24个月或60个月PRS改善(p>0.05)。
结论：SNMM与高复发率和低生存率相关。颈部的主要治疗与减少复发无关。治疗远处复发的免疫治疗与12个月PRS增加相关。本文受版权保护。保留所有权利。
