Hanna Eriksson, Eva Månsson-Brahme, Margareta Frohm-Nilsson, and Johan Hansson, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm; Johan Lyth and Christer Lindholm, Regional Cancer Center Southeast, Linköping University Hospital; Johan Lyth and John Carstensen, Linköping University, Linköping; Christian Ingvar, Lund University, Lund; Peter Naredi, Sahlgrenska Academy; and Ulrika Stierner, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Clin Oncol. 2014 May 1;32(13):1356-64. doi: 10.1200/JCO.2013.52.7564. Epub 2014 Mar 31.
To investigate the association between cohabitation status, clinical stage at diagnosis, and disease-specific survival in cutaneous malignant melanoma (CMM).
This nationwide population-based study included 27,235 patients from the Swedish Melanoma Register diagnosed with a primary invasive CMM between 1990 and 2007 and linked data to nationwide, population-based registers followed up through 2012.
After adjustment for age at diagnosis, level of education, living area, period of diagnosis, and tumor site, the odds ratios (ORs) of higher stage at diagnosis were significantly increased among men living alone versus men living with a partner (stage II v stage I: OR, 1.42; 95% CI, 1.29 to 1.57; stage III or IV v stage I: OR, 1.43; 95% CI, 1.14 to 1.79). The OR for stage II versus stage I disease was also increased among women living alone (OR, 1.15; 95% CI, 1.04 to 1.28). After adjustments for the factors listed earlier, the CMM-specific survival was significantly decreased among men living alone (hazard ratio [HR] for death, 1.48; 95% CI, 1.33 to 1.65; P < .001). After additional adjustments for all potential and established prognostic factors, CMM-specific survival among men living alone versus men living with a partner remained significantly decreased (HR, 1.31; 95% CI, 1.18 to 1.46; P < .001), suggesting a residual adverse effect on survival not accounted for by these parameters.
In all age groups among men, living alone is significantly associated with reduced CMM-specific survival, partially attributed to a more advanced stage at diagnosis. This emphasizes the need for improved prevention and early detection strategies for this group.
探讨同居状况、诊断时的临床分期与皮肤恶性黑色素瘤（CMM）患者疾病特异性生存之间的相关性。
本项全国性基于人群的研究纳入了 1990 年至 2007 年间在瑞典黑色素瘤登记处诊断为原发性侵袭性 CMM 的 27235 例患者，并将数据与全国性基于人群的登记处进行了关联，这些登记处的随访截止日期为 2012 年。
在调整了诊断时的年龄、教育程度、居住区域、诊断时期和肿瘤部位后，与与伴侣同居的男性相比，独居男性诊断时更高分期的优势比（OR）显著增加（II 期比 I 期：OR=1.42；95%CI，1.29 至 1.57；III 期或 IV 期比 I 期：OR=1.43；95%CI，1.14 至 1.79）。独居女性的 II 期与 I 期疾病的 OR 也有所增加（OR=1.15；95%CI，1.04 至 1.28）。在调整了上述所有因素后，独居男性的 CMM 特异性生存率显著降低（死亡风险比[HR]，1.48；95%CI，1.33 至 1.65；P<0.001）。在进一步调整所有潜在和已确定的预后因素后，独居男性与同居男性相比，CMM 特异性生存率仍显著降低（HR，1.31；95%CI，1.18 至 1.46；P<0.001），这表明生存方面存在残余的不利影响，这些参数无法解释这一影响。
在所有年龄段的男性中，独居与 CMM 特异性生存率降低显著相关，部分原因是诊断时的分期更晚。这强调了需要为这一群体制定更好的预防和早期发现策略。
