Youlden Danny R, Baade Peter D, Soyer H Peter, Youl Philippa H, Kimlin Michael G, Aitken Joanne F, Green Adele C, Khosrotehrani Kiarash
Cancer Council Queensland, Brisbane, Queensland, Australia.
Cancer Council Queensland, Brisbane, Queensland, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
J Invest Dermatol. 2016 Nov;136(11):2270-2276. doi: 10.1016/j.jid.2016.03.014. Epub 2016 Mar 24.
The prognosis of melanoma patients who are diagnosed with multiple primary lesions remains controversial. We used a large population-based cohort to re-examine this issue, applying a delayed entry methodology to avoid survival bias. Of 32,238 eligible patients diagnosed between 1995 and 2008, 29,908 (93%) had a single invasive melanoma, 2,075 (6%) had two, and 255 (1%) had three. Allowing for differences in entry time, 10-year cause-specific survival for these three groups was 89% (95% confidence interval [CI] = 88-90%), 83% (95% CI = 80-86%), and 67% (95% CI = 54-81%), respectively. After adjustment for key prognostic factors, the hazard ratio of death within 10 years from melanoma was two times higher for those with two melanomas (hazard ratio = 2.01, 95% CI = 1.57-2.59; P < 0.001) and nearly three times higher when three melanomas were diagnosed (hazard ratio = 2.91, 95% CI = 1.64-5.18; P < 0.001) compared with people with a single melanoma. Melanoma-specific mortality remained elevated after adjusting for maximum thickness or ulceration of any melanoma regardless of the index tumor. After appropriately accounting for the interval between diagnosis of the first and subsequent melanomas, patients with multiple invasive melanomas have significantly poorer survival than patients with a single invasive melanoma.
被诊断为多发原发性病灶的黑色素瘤患者的预后仍存在争议。我们使用了一个基于人群的大型队列，采用延迟入组方法以避免生存偏差，重新审视了这个问题。在1995年至2008年间确诊的32238例符合条件的患者中，29908例（93%）患有单一侵袭性黑色素瘤，2075例（6%）患有两种，255例（1%）患有三种。考虑到入组时间的差异，这三组患者的10年病因特异性生存率分别为89%（95%置信区间[CI]=88 - 90%）、83%（95%CI = 80 - 86%）和67%（95%CI = 54 - 81%）。在对关键预后因素进行调整后，与患有单一黑色素瘤的患者相比，患有两种黑色素瘤的患者10年内死于黑色素瘤的风险比高出两倍（风险比 = 2.01，95%CI = 1.57 - 2.59；P < 0.001），而被诊断为三种黑色素瘤时则高出近三倍（风险比 = 2.91，95%CI = 1.64 - 5.18；P < 0.001）。无论索引肿瘤如何，在对任何黑色素瘤的最大厚度或溃疡情况进行调整后，黑色素瘤特异性死亡率仍然升高。在适当考虑首次和后续黑色素瘤诊断之间的间隔后，患有多发侵袭性黑色素瘤的患者的生存率明显低于患有单一侵袭性黑色素瘤的患者。
