Lyth Johan
Research and Development Unit in Region Östergötland, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Melanoma Res. 2018 Dec;28(6):637-640. doi: 10.1097/CMR.0000000000000479.
Conditional survival in patients with localized primary cutaneous malignant melanoma (CMM) is well described. However, conditional recurrence-free survival (RFS) has not been investigated before. The aim of this study was to determine conditional RFS and test for time dependency in prognostic factors in patients with localized stage I-II CMM. This study included 1437 CMM patients registered in one region of Sweden during 1999-2012 followed up through 31 December 2012. To identify first recurrence of CMM disease, data from a care data warehouse, the pathology and radiology department registries were used. Patients were also followed through a Census Register and the National Cause of Death Register. The time-dependent risk of recurrence was analysed in a Cox's proportional hazard regression. The 5-year conditional RFS increased from 86% (95% confidence interval: 84-88) at diagnosis to 96% (95% confidence interval: 94-98) at 5 years after diagnosis. Women showed a 60% lower risk of recurrence than men and this effect was stable over time (P=0.39). Patients aged greater than or equal to 65 years had a 40% higher risk of recurrence than patients aged less than 65 years, and this effect was stable over time (P=0.65). Patients with tumour ulceration showed a 70% higher risk of recurrence than nonulcerated patients, but this effect disappeared after 2 years (P=0.04). For patients with T3-T4 CMM, the hazard ratios decreased over time and were similar to hazard ratio of patients with T2 CMM after 2 years and later. The decreasing impact of tumour thickness and ulceration over time could have important implications for CMM patients in terms of counselling and follow-up.
局限性原发性皮肤恶性黑色素瘤（CMM）患者的条件生存情况已有详尽描述。然而，此前尚未对条件无复发生存期（RFS）进行过研究。本研究的目的是确定局限性Ⅰ - Ⅱ期CMM患者的条件RFS，并检验预后因素的时间依赖性。本研究纳入了1999年至2012年期间在瑞典一个地区登记的1437例CMM患者，随访至2012年12月31日。为确定CMM疾病的首次复发情况，使用了来自医疗数据仓库、病理和放射科登记处的数据。患者还通过人口普查登记册和国家死亡原因登记册进行随访。在Cox比例风险回归中分析复发的时间依赖性风险。5年条件RFS从诊断时的86%（95%置信区间：84 - 88）增加到诊断后5年的96%（95%置信区间：94 - 98）。女性复发风险比男性低60%，且这种效应随时间稳定（P = 0.39）。年龄大于或等于65岁的患者复发风险比年龄小于65岁的患者高40%，且这种效应随时间稳定（P = 0.65）。有肿瘤溃疡的患者复发风险比无溃疡患者高70%，但这种效应在2年后消失（P = 0.04）。对于T3 - T4期CMM患者，风险比随时间下降，2年后及以后与T2期CMM患者的风险比相似。肿瘤厚度和溃疡随时间影响的降低对于CMM患者的咨询和随访可能具有重要意义。
