Banerjee Mousumi, Lao Christopher D, Wancata Lauren M, Muenz Daniel G, Haymart Megan R, Wong Sandra L
aDepartment of Biostatistics bDepartment of Medicine, Division of Hematology/Oncology cDepartment of Surgery dDepartment of Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA.
Melanoma Res. 2016 Feb;26(1):77-82. doi: 10.1097/CMR.0000000000000213.
Overall cancer incidence is decreasing, whereas melanoma cases are increasing. Conditional survival estimates offer a more accurate prognosis for patients the farther they are from time of diagnosis. The effect of age and stage on a melanoma patient's conditional survival estimate is unknown. Surveillance, Epidemiology, and End Results data were utilized to identify newly diagnosed cutaneous melanoma patients (N=95 041), from 1998 to 2005, with up to 12 years of follow-up. Estimates of disease-specific survival by stage and age were determined by Cox regression analysis and transformed to estimated conditional 5-year survival. Localized melanoma patients have an excellent 5-year survival at diagnosis and over subsequent years. For patients with localized and regional disease, an age effect is present for disease-specific mortality when comparing older patients (70-79 years) with younger patients (<30 years): hazard ratio (HR) for mortality 3.79 [95% confidence interval (CI) 3.01-4.84] and HR 2.36 (95% CI 1.93-2.91), respectively. No age effect difference is observed in disease-specific survival for advanced disease: HR 1.14 (95% CI 0.87-1.53). Over time, conditional survival estimates improve for older patients with localized and regional disease. This improvement is not seen in distant disease, neither is the age gradient. Disease-specific mortality and conditional survival for patients with localized and regional melanomas are initially impacted by older age, with effects dissipating over time. Age does not affect survival in patients with advanced disease. Understanding the conditional 5-year disease-specific survival of melanoma based on age and stage can help patients and physicians, informing decision-making about treatment and surveillance.
总体癌症发病率在下降，而黑色素瘤病例却在增加。条件生存估计为离诊断时间越远的患者提供了更准确的预后。年龄和分期对黑色素瘤患者条件生存估计的影响尚不清楚。利用监测、流行病学和最终结果数据，识别出1998年至2005年新诊断的皮肤黑色素瘤患者（N = 95041），随访时间长达12年。通过Cox回归分析确定按分期和年龄的疾病特异性生存估计，并转换为估计的条件5年生存率。局限性黑色素瘤患者在诊断时及随后几年的5年生存率很高。对于局限性和区域性疾病患者，将老年患者（70 - 79岁）与年轻患者（<30岁）相比，疾病特异性死亡率存在年龄效应：死亡率的风险比（HR）分别为3.79 [95%置信区间（CI）3.01 - 4.84]和HR 2.36（95% CI 1.93 - 2.91）。对于晚期疾病，在疾病特异性生存方面未观察到年龄效应差异：HR为1.14（95% CI 0.87 - 1.53）。随着时间的推移，局限性和区域性疾病老年患者的条件生存估计有所改善。远处疾病未出现这种改善，年龄梯度也未出现。局限性和区域性黑色素瘤患者的疾病特异性死亡率和条件生存最初受年龄影响，随着时间推移影响逐渐消散。年龄不影响晚期疾病患者的生存。了解基于年龄和分期的黑色素瘤条件5年疾病特异性生存情况有助于患者和医生，为治疗和监测决策提供信息。
