Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
J Am Acad Dermatol. 2011 Nov;65(5 Suppl 1):S69-77. doi: 10.1016/j.jaad.2011.04.033.
An estimated 750,000 melanoma survivors in the United States are at increased risk of subsequent primary cancers.
We sought to assess the risk of developing subsequent primary cancers among people with cutaneous melanoma.
Using 1992 to 2006 data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program, 40,881 people with in situ melanoma and 76,041 people with invasive melanoma were followed up (mean of 5.6 years) for the development of subsequent primary cancers. The observed number of subsequent cancers was compared with those expected based on age-/race-/year-/site-specific rates in the Surveillance, Epidemiology, and End Results population. Standardized incidence ratios (SIRs) (SIR = observed number/expected number) were considered statistically significant if they differed from 1, with an alpha level of 0.05.
After a first primary in situ melanoma, risk was significantly elevated for subsequent invasive melanoma and chronic lymphocytic leukemia among men (SIRs = 8.43 and 1.44, respectively) and women (SIRs = 12.33 and 1.79, respectively). After a first primary invasive melanoma, risk was significantly elevated for subsequent invasive melanoma, thyroid cancer, non-Hodgkin lymphoma, and chronic lymphocytic leukemia among both men (SIRs = 12.50, 2.67, 1.56, and 1.57, respectively) and women (SIRs = 15.67, 1.77, 1.42, and 1.63, respectively).
Case ascertainment issues particularly affecting in situ melanoma cases could affect results. The role of detection bias in the diagnoses of some subsequent cancers cannot be completely eliminated.
The findings of the study should guide the development of strategies such as posttreatment surveillance, screening, and ultraviolet exposure education among melanoma survivors to improve cancer survivorship.
据估计，美国有 75 万黑色素瘤幸存者存在继发原发性癌症的风险增加。
我们旨在评估患有皮肤黑色素瘤的人群发生继发原发性癌症的风险。
利用美国国家癌症研究所监测、流行病学和最终结果计划（1992 年至 2006 年）的数据，对 40881 例原位黑色素瘤和 76041 例侵袭性黑色素瘤患者进行了随访（平均随访时间为 5.6 年），以观察继发原发性癌症的发生情况。将观察到的癌症数量与监测、流行病学和最终结果人群中基于年龄/种族/年份/部位特异性的预期数量进行比较。如果标准化发病率比（SIR）（SIR=观察数量/预期数量）与 1 不同，则认为差异具有统计学意义，置信区间上限为 0.05。
男性和女性的第一原发性原位黑色素瘤后，发生侵袭性黑色素瘤和慢性淋巴细胞白血病的风险显著升高（SIR 分别为 8.43 和 1.44）。男性和女性的第一原发性侵袭性黑色素瘤后，发生侵袭性黑色素瘤、甲状腺癌、非霍奇金淋巴瘤和慢性淋巴细胞白血病的风险显著升高（SIR 分别为 12.50、2.67、1.56 和 1.57）。
可能影响结果的病例检出问题尤其会影响原位黑色素瘤病例。某些继发癌症的诊断中检测偏倚的作用不能完全消除。
本研究的发现应指导策略的制定，如对黑色素瘤幸存者进行治疗后监测、筛查和紫外线暴露教育，以提高癌症生存质量。
