Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Ann Surg Oncol. 2010 Jun;17(6):1662-8. doi: 10.1245/s10434-010-0965-8. Epub 2010 Feb 18.
Survival curves following surgical treatment of cutaneous melanoma are heavily influenced by early deaths. Therefore, survival estimates may be misleading for long-term cancer survivors. We examined whether conditional survival (CS) is more accurate in predicting long-term melanoma survival.
We used the Surveillance, Epidemiology, and End Results database (1992-2005) to identify patients who underwent surgical treatment for melanoma. We included patients with T2-T4 disease and with known nodal status. Patients were stratified into low-risk (T2-3N0M0) and high-risk (T4N0M0 or T2-4N1-3M0) categories. We defined CS as time-specific estimates conditioned on living to a certain point in follow-up, and calculated 10-year cancer-specific survival curves conditioned on annual survival. We adjusted for potential confounders using a Cox proportional hazards regression model (alpha = 0.05).
A total of 8647 patients met inclusion criteria (low-risk, 5987 [69.2%]; high-risk, 2660 [30.8%]). At diagnosis, low-risk patients had a significantly better 10-year survival rate (low-risk, 79.6%; high-risk, 41.2%; P < 0.001). On CS analysis, survival differences remained until 8 years after treatment, after which 10-year cancer-specific survival rates were no longer significantly different (P = 0.51) for low-risk (95.4%) and high-risk (91.7%) groups. Multivariate analysis demonstrated that age, gender, location, and ulceration (initial predictors of survival) were no longer predictive after 8 years of survival.
For patients who survive 8 years after surgical treatment of melanoma, CS data become discordant with traditionally used estimates. Our findings have important implications for patient counseling, as high-risk melanoma survivors may require no more intensive surveillance than low-risk survivors 8 years after treatment.
皮肤黑色素瘤手术后的生存曲线受早期死亡的影响很大。因此，生存估计可能会对长期癌症幸存者产生误导。我们研究了条件生存（CS）是否更能准确预测黑色素瘤的长期生存。
我们使用监测、流行病学和最终结果数据库（1992-2005 年）来确定接受手术治疗黑色素瘤的患者。我们纳入了 T2-T4 疾病和已知淋巴结状态的患者。患者分为低风险（T2-3N0M0）和高风险（T4N0M0 或 T2-4N1-3M0）。我们将 CS 定义为随访特定时间点的时间特异性估计，并根据每年的生存率计算 10 年癌症特异性生存率。我们使用 Cox 比例风险回归模型（alpha = 0.05）调整潜在混杂因素。
共有 8647 名患者符合纳入标准（低风险组 5987 名[69.2%]；高风险组 2660 名[30.8%]）。在诊断时，低风险患者的 10 年生存率明显更高（低风险组为 79.6%；高风险组为 41.2%；P<0.001）。在 CS 分析中，生存差异持续到治疗后 8 年，此后低风险（95.4%）和高风险（91.7%）组的 10 年癌症特异性生存率不再有显著差异（P=0.51）。多变量分析表明，年龄、性别、部位和溃疡（生存的初始预测因素）在生存 8 年后不再具有预测性。
对于手术后生存 8 年的黑色素瘤患者，CS 数据与传统使用的估计结果不一致。我们的研究结果对患者咨询具有重要意义，因为高危黑色素瘤幸存者在治疗后 8 年可能不需要比低危幸存者更密集的监测。
