University of Colorado Cancer Center, University of Colorado, Aurora, Colorado.
University of Colorado Cancer Center, University of Colorado, Aurora, Colorado; Department of Medicine-Biomedical Informatics and Personalized Medicine, School of Medicine, University of Colorado, Aurora, Colorado.
J Am Acad Dermatol. 2019 Jun;80(6):1640-1649. doi: 10.1016/j.jaad.2019.01.009. Epub 2019 Jan 14.
Clinical guidelines for the treatment of melanoma are based largely on the behavior of thicker tumors. As a result, little is known about survival differences among patients with thinner tumors.
To investigate the variability in survival for American Joint Committee on Cancer stage T1 thin melanoma tumors, defined as tumors less than 1 mm thick at diagnosis.
This population-based series included 43,008 non-Hispanic whites in whom cutaneous melanoma was diagnosed between 2004 and 2013 from the California Cancer Registry. Survival outcomes were estimated using the Kaplan-Meier method. Cox proportional hazard models were used to estimate risk of death.
Survival for patients with thin ulcerated tumors was comparable to that for patients with stage II tumors, who are currently treated more aggressively. At 12 months, patients with thin ulcerated tumors had approximately 6% lower survival (92.5% [95% confidence interval (CI), 90.6%-93.9%]) compared with patients with thin nonulcerated tumors (98.2% [95% CI, 98.0%-98.3%]). At 24 months, this survival difference increased (85.2% [95% CI, 82.8%-87.4%] vs 96.1% [95% CI, 95.8-96.3%] for those with thin ulcerated and thin nonulcerated tumors, respectively) and a greater than 15% survival difference was seen at 60 months.
Previous reports of cancer registry data have noted some evidence of miscoding of thin tumors.
The poorer survival in patients with ulcerated tumors less than 1 mm thick implies the need for additional studies to determine potential benefits of more aggressive treatment.
黑色素瘤治疗的临床指南主要基于较厚肿瘤的行为。因此，对于较薄肿瘤患者的生存差异知之甚少。
研究美国癌症联合委员会 T1 期薄型黑色素瘤肿瘤（定义为诊断时厚度小于 1 毫米的肿瘤）患者生存的可变性。
本基于人群的系列研究包括 2004 年至 2013 年间加利福尼亚癌症登记处诊断为皮肤黑色素瘤的 43008 名非西班牙裔白人患者。使用 Kaplan-Meier 方法估计生存结果。使用 Cox 比例风险模型估计死亡风险。
薄溃疡性肿瘤患者的生存情况与目前治疗更积极的 II 期肿瘤患者相当。在 12 个月时，薄溃疡性肿瘤患者的生存率略低（92.5%[95%置信区间（CI），90.6%-93.9%]），而薄非溃疡性肿瘤患者为 98.2%[95%CI，98.0%-98.3%]）。在 24 个月时，这种生存差异增加（分别为 85.2%[95%CI，82.8%-87.4%]和 96.1%[95%CI，95.8%-96.3%]），在 60 个月时，生存率差异超过 15%。
先前关于癌症登记数据的报告指出，薄肿瘤的编码存在一些错误。
溃疡性肿瘤厚度小于 1 毫米的患者生存率较差，这意味着需要进一步研究以确定更积极治疗的潜在益处。
