Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia.
Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia.
JAMA Dermatol. 2018 May 1;154(5):574-580. doi: 10.1001/jamadermatol.2018.0233.
Early detection of melanoma is associated with improved patient outcomes. Data suggest that spouses or partners may facilitate detection of melanoma before the onset of regional and distant metastases. Less well known is the influence of marital status on the detection of early clinically localized melanoma.
To evaluate the association between marital status and T stage at the time of presentation with early-stage melanoma and the decision for sentinel lymph node biopsy (SLNB) in appropriate patients.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based study used the Surveillance, Epidemiology, and End Results database of 18 population-based registered cancer institutes. Patients with cutaneous melanoma who were at least 18 years of age and without evidence of regional or distant metastases and presented from January 1, 2010, through December 31, 2014, were identified for the study. Data were analyzed from September 27 to December 5, 2017.
Marital status, categorized as married, never married, divorced, or widowed.
Clinical T stage at presentation and performance of SLNB for lesions with Breslow thickness greater than 1 mm.
A total of 52 063 patients were identified (58.8% men and 41.2% women; median age, 64 years; interquartile range, 52-75 years). Among married patients, 16 603 (45.7%) presented with T1a disease, compared with 3253 never married patients (43.0%), 1422 divorced patients (39.0%), and 1461 widowed patients (32.2%) (P < .001). Conversely, 428 widowed patients (9.4%) presented with T4b disease compared with 1188 married patients (3.3%) (P < .001). The association between marital status and higher T stage at presentation remained significant among never married (odds ratio [OR], 1.32; 95% CI, 1.26-1.39; P < .001), divorced (OR, 1.38; 95% CI, 1.30-1.47; P < .001), and widowed (OR, 1.70; 95% CI, 1.60-1.81; P < .001) patients after adjustment for various socioeconomic and patient factors. Independent of T stage and other patient factors, married patients were more likely to undergo SLNB in lesions with Breslow thickness greater than 1 mm, for which SLNB is routinely recommended, compared with never married (OR, 0.59; 95% CI, 0.53-0.65; P < .001), divorced (OR, 0.87; 95% CI, 0.76-0.99; P = .03), and widowed (OR, 0.69; 95% CI, 0.62-0.76; P < .001) patients.
Marital status is associated with earlier presentation of localized melanoma. Moreover, never married, divorced, and widowed patients are less likely to undergo SLNB for appropriate lesions. Marital status should be considered when counseling patients for melanoma procedures and when recommending screening and follow-up to optimize patient care.
早期发现黑色素瘤与改善患者预后相关。有数据表明，配偶或伴侣可能有助于在区域性和远处转移发生之前发现黑色素瘤。然而，婚姻状况对早期临床局限性黑色素瘤的检测影响却鲜为人知。
评估婚姻状况与早期黑色素瘤患者就诊时 T 分期以及在适当患者中进行前哨淋巴结活检 (SLNB) 的决策之间的关系。
设计、地点和参与者：本回顾性基于人群的研究使用了 18 个基于人群的癌症研究所的监测、流行病学和最终结果数据库。研究纳入了至少 18 岁、无区域或远处转移且于 2010 年 1 月 1 日至 2014 年 12 月 31 日就诊的皮肤黑色素瘤患者。数据分析于 2017 年 9 月 27 日至 12 月 5 日进行。
婚姻状况，分为已婚、未婚、离婚和丧偶。
就诊时的临床 T 分期和 Breslow 厚度大于 1mm 的病变行 SLNB 的情况。
共确定了 52063 名患者（58.8%为男性，41.2%为女性；中位年龄为 64 岁；四分位距为 52-75 岁）。在已婚患者中，16603 名（45.7%）患者为 T1a 期疾病，而未婚患者为 3253 名（43.0%），离婚患者为 1422 名（39.0%），丧偶患者为 1461 名（32.2%）（P < .001）。相比之下，428 名丧偶患者（9.4%）为 T4b 期疾病，而 1188 名已婚患者（3.3%）为 T4b 期疾病（P < .001）。在未婚（比值比 [OR]，1.32；95%置信区间 [CI]，1.26-1.39；P < .001）、离婚（OR，1.38；95% CI，1.30-1.47；P < .001）和丧偶（OR，1.70；95% CI，1.60-1.81；P < .001）患者中，即使在调整了各种社会经济和患者因素后，婚姻状况与就诊时较高的 T 分期仍存在显著关联。无论 T 分期和其他患者因素如何，与未婚（OR，0.59；95% CI，0.53-0.65；P < .001）、离婚（OR，0.87；95% CI，0.76-0.99；P = .03）和丧偶（OR，0.69；95% CI，0.62-0.76；P < .001）患者相比，已婚患者更有可能对 Breslow 厚度大于 1mm 的病变进行 SLNB，因为 SLNB 通常建议对这类病变进行。
婚姻状况与局限性黑色素瘤的早期就诊相关。此外，未婚、离婚和丧偶患者不太可能对适当的病变进行 SLNB。在为黑色素瘤患者提供咨询以及推荐筛查和随访以优化患者护理时，应考虑婚姻状况。
