Dermatology Service, Veterans Affairs Palo Alto Health Care System, and Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center, Palo Alto, California.
JAMA Dermatol. 2013 Aug;149(8):912-20. doi: 10.1001/jamadermatol.2013.4408.
Worse survival among patients with melanoma has been demonstrated in middle-aged and older men compared with women, but few studies have explored survival differences by sex in adolescents and young adults, in whom melanoma is the third most common cancer. Focusing on sex disparities in survival among younger individuals may provide further evidence of biological rather than behavioral factors that affect melanoma outcome.
To determine whether long-term survival varies between white male and female adolescents and young adults with melanoma (15 to 39 years of age at diagnosis) in the United States.
DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort with a mean follow-up of 7.5 years of 26,107 non-Hispanic white adolescents and young adults with primary invasive melanoma of the skin diagnosed from January 1, 1989, through December 31, 2009, and reported to the Surveillance, Epidemiology, and End Results network of cancer registries.
Melanoma-specific survival.
There were 1561 melanoma-specific deaths in the study population. Although adolescent and young adult males accounted for fewer overall melanoma cases (39.8%) than females, they comprised 63.6% of melanoma-specific deaths. Adolescent and young adult males were 55% more likely to die of melanoma than age-matched females after adjustment for tumor thickness, histologic subtype, presence and extent of metastasis, and anatomical location (hazard ratio, 1.55; 95% CI, 1.39-1.73). Males were also more likely to die within each age range assessed (eg, 15-24, 25-29, 30-34, and 35-39 years), and even those with thin melanomas (≤1.00 mm) were twice as likely to die as age-matched females (hazard ratio, 1.95; 95% CI, 1.57-2.42). Adjustment for health insurance and socioeconomic status in a subanalysis did not significantly alter these results.
Male sex is associated with worse survival among white adolescents and young adults with melanoma after controlling for thickness and other prognostic factors. Continued public health efforts are necessary to raise awareness of the outcome of melanoma in young men. Further investigation of possible biological mechanisms that account for these sex differences is merited.
与女性相比，中年和老年男性的黑色素瘤患者生存率更差，但很少有研究探讨青少年和年轻成年人中性别对生存率的影响，在这些人群中，黑色素瘤是第三大常见癌症。关注年轻个体中生存的性别差异可能为影响黑色素瘤结果的生物学因素而非行为因素提供更多证据。
确定在美国，15 至 39 岁诊断为黑色素瘤（皮肤原发性浸润性黑色素瘤）的白种男性和女性青少年和年轻成年人之间，长期生存是否存在差异。
设计、地点和参与者：基于人群的队列研究，平均随访时间为 7.5 年，纳入 1989 年 1 月 1 日至 2009 年 12 月 31 日期间通过癌症登记处的监测、流行病学和最终结果网络报告的 26107 例非西班牙裔白种青少年和年轻成年人原发性皮肤黑色素瘤病例。
黑色素瘤特异性生存率。
研究人群中共有 1561 例黑色素瘤特异性死亡。尽管青少年和年轻男性黑色素瘤病例总数（39.8%）少于女性，但他们占黑色素瘤特异性死亡的 63.6%。调整肿瘤厚度、组织学亚型、转移存在和范围以及解剖位置后，青少年和年轻男性死于黑色素瘤的可能性比年龄匹配的女性高 55%（风险比，1.55；95%CI，1.39-1.73）。男性也更有可能在每个评估的年龄范围内死亡（例如，15-24 岁、25-29 岁、30-34 岁和 35-39 岁），甚至那些患有薄型黑色素瘤（≤1.00mm）的男性死于黑色素瘤的可能性也是年龄匹配女性的两倍（风险比，1.95；95%CI，1.57-2.42）。亚分析中调整医疗保险和社会经济地位并未显著改变这些结果。
在控制厚度和其他预后因素后，男性性别与白种青少年和年轻成年人黑色素瘤的生存较差相关。需要继续开展公共卫生努力，提高人们对年轻男性黑色素瘤结局的认识。进一步研究可能导致这些性别差异的生物学机制是值得的。
