Brewer Jerry D, Christenson Leslie J, Weaver Amy L, Dapprich Daniel C, Weenig Roger H, Lim Katherine K, Walsh John S, Otley Clark C, Cherikh Wida, Buell Joseph F, Woodle E Steve, Arpey Christopher, Patton Pamela R
Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA.
Arch Dermatol. 2011 Jul;147(7):790-6. doi: 10.1001/archdermatol.2011.159.
To determine malignant melanoma cause-specific and overall survival among patients with melanoma diagnosed after organ transplantation compared with a national sample with malignant melanoma.
Retrospective review.
Mayo Clinic sites.
Immunosuppressed organ transplant recipients with malignant melanoma identified from surgical and medical databases at Mayo Clinic (1978-2007), the Organ Procurement and Transplantation Network/United Network for Organ Sharing database (1999-2006), and the Israel Penn International Transplant Tumor Registry (1967-2007).
Prognostic analyses by Breslow thickness and Clark level of overall and melanoma cause-specific survival. Expected survival rates were estimated by applying the age-, sex-, and calendar year-specific survival rates of patients with malignant melanoma cases reported in the Surveillance, Epidemiology, and End Results Program to the study cohort.
Malignant melanoma was diagnosed in 638 patients (724 cases) after transplantation. Breslow thickness was available for 123 patients; Clark level, for 175. Three-year overall survival rates for patients stratified by Breslow thickness (≤ 0.75, 0.76-1.50, 1.51-3.00, and >3.00 mm) were 88.2%, 80.8%, 51.2%, and 55.3%, respectively, and 3-year cause-specific survival rates (95% confidence intervals) were 97.8% (93.7%-100%), 89.4% (76.5%-100%), 73.2% (53.2%-100%), and 73.9% (56.4%-96.6%), respectively. Three-year cause-specific survival rates (95% confidence intervals) for patients stratified by Clark level (I-IV) were 100%, 97.4% (92.4%-100%), 82.8% (65.3%-100%), and 65.8% (51.8%-83.7%), respectively. For patients with Breslow thickness of 1.51 to 3.00 mm and Clark level III or IV, the cause-specific survival rate in the study sample was significantly different from the expected estimates for patients with the same Breslow thickness or Clark level.
Compared with the expected survival rates derived from malignant melanoma cases reported in the Surveillance, Epidemiology, and End Results Program, immunosuppressed organ transplant recipients with thicker melanomas (ie, with a Clark level of III or IV or a Breslow thickness of 1.51 to 3.00 mm) had a significantly poorer malignant melanoma cause-specific survival rate. The overall survival rate was worse among patients with a prior history of transplantation, regardless of Breslow thickness or Clark level.
确定器官移植后诊断为黑色素瘤的患者中，特定病因的恶性黑色素瘤生存率及总生存率，并与全国性黑色素瘤样本进行比较。
回顾性研究。
梅奥诊所各院区。
从梅奥诊所（1978 - 2007年）的外科和医学数据库、器官获取与移植网络/器官共享联合网络数据库（1999 - 2006年）以及以色列佩恩国际移植肿瘤登记处（1967 - 2007年）中识别出的接受免疫抑制治疗的器官移植受者，且患有恶性黑色素瘤。
根据Breslow厚度和Clark分级对总生存率及特定病因的黑色素瘤生存率进行预后分析。通过将监测、流行病学和最终结果计划中报告的恶性黑色素瘤患者的年龄、性别和年份特异性生存率应用于研究队列，来估计预期生存率。
638例患者（724例病例）在移植后被诊断为恶性黑色素瘤。123例患者有Breslow厚度数据；175例有Clark分级数据。根据Breslow厚度分层（≤0.75、0.76 - 1.50、1.51 - 3.00和>3.00 mm）的患者三年总生存率分别为88.2%、80.8%、51.2%和55.3%，三年特定病因生存率（95%置信区间）分别为97.8%（93.7% - 100%）、89.4%（76.5% - 100%）、73.2%（53.2% - 100%）和73.9%（56.4% - 96.6%）。根据Clark分级（I - IV级）分层的患者三年特定病因生存率（95%置信区间）分别为100%、97.4%（92.4% - 100%）、82.8%（65.3% - 100%）和65.8%（51.8% - 83.7%）。对于Breslow厚度为1.51至3.00 mm且Clark分级为III或IV级的患者，研究样本中的特定病因生存率与相同Breslow厚度或Clark分级患者的预期估计值有显著差异。
与监测、流行病学和最终结果计划中报告的恶性黑色素瘤病例的预期生存率相比，黑色素瘤较厚（即Clark分级为III或IV级或Breslow厚度为1.51至3.00 mm）的接受免疫抑制治疗的器官移植受者，其特定病因的恶性黑色素瘤生存率显著更差。无论Breslow厚度或Clark分级如何，有移植史患者的总生存率更差。
