Abdel-Rahman Omar
a Clinical Oncology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
J Dermatolog Treat. 2018 Mar;29(2):176-181. doi: 10.1080/09546634.2017.1360987. Epub 2017 Aug 11.
Population-based data on the clinical correlates and prognostic value of the pattern of metastases among patients with cutaneous melanoma are needed.
Surveillance, Epidemiology and End Results (SEER) database (2010-2013) has been explored through SEER*Stat program. For each of six distant metastatic sites (bone, brain, liver, lung, distant lymph nodes, and skin/subcutaneous), relevant correlation with baseline characteristics were reported. Survival analysis has been conducted through Kaplan-Meier analysis, and multivariate analysis has been conducted through a Cox proportional hazard model.
A total of 2691 patients with metastatic cutaneous melanoma were identified in the period from 2010 to 2013. Patients with isolated skin/subcutaneous metastases have the best overall and melanoma-specific survival (MSS) followed by patients with isolated distant lymph node metastases followed by patients with isolated lung metastases. Patients with isolated liver, bone, or brain metastases have the worst overall and MSS (p < .0001 for both end points). Multivariate analysis revealed that age more than 70 at diagnosis (p = .012); multiple sites of metastases (p <.0001), no surgery to the primary tumor (p <.0001), and no surgery to the metastatic disease (p < .0001) were associated with worse overall survival (OS). For MSS, nodal positivity (p = .038), multiple sites of metastases (p < .0001), no surgery to the primary tumor (p < .0001), and no surgery to the metastatic disease (p < .0001) were associated with worse survival.
The prognosis of metastatic cutaneous melanoma patients differs considerably according to the site of distant metastases. Further prospective studies are required to evaluate the role of local treatment in the management of metastatic disease.
需要基于人群的数据来了解皮肤黑色素瘤患者转移模式的临床相关性和预后价值。
通过SEER*Stat程序对监测、流行病学和最终结果（SEER）数据库（2010 - 2013年）进行了探索。报告了六个远处转移部位（骨、脑、肝、肺、远处淋巴结和皮肤/皮下组织）中每个部位与基线特征的相关情况。通过Kaplan-Meier分析进行生存分析，并通过Cox比例风险模型进行多变量分析。
在2010年至2013年期间共确定了2691例转移性皮肤黑色素瘤患者。孤立性皮肤/皮下转移患者的总生存期和黑色素瘤特异性生存期（MSS）最佳，其次是孤立性远处淋巴结转移患者，然后是孤立性肺转移患者。孤立性肝、骨或脑转移患者的总生存期和MSS最差（两个终点的p值均<0.0001）。多变量分析显示，诊断时年龄超过70岁（p = 0.012）；转移部位多（p < 0.0001），原发肿瘤未手术（p < 0.0001），以及转移病灶未手术（p < 0.0001）与较差的总生存期（OS）相关。对于MSS，淋巴结阳性（p = 0.038）、转移部位多（p < 0.0001）、原发肿瘤未手术（p < 0.0001）以及转移病灶未手术（p < 0.0001）与较差的生存期相关。
转移性皮肤黑色素瘤患者的预后根据远处转移部位的不同有很大差异。需要进一步的前瞻性研究来评估局部治疗在转移性疾病管理中的作用。
