Zheng Guoqiao, Chattopadhyay Subhayan, Sundquist Kristina, Sundquist Jan, Försti Asta, Hemminki Akseli, Hemminki Kari
Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg D-69120, Germany.
Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
Clin Epidemiol. 2020 Jan 23;12:105-112. doi: 10.2147/CLEP.S230149. eCollection 2020.
Survival in malignant cutaneous melanoma has improved but increasing survival will result in an increased likelihood of the occurrence of second primary cancers (SPCs). SPCs may adversely interfere with survival. We quantified survival in patients with different types of SPCs, in comparison to known poor prognostic indicators of metastatic disease.
Data for melanoma and any SPCs were obtained from the Swedish Cancer Registry for years 2003 through 2015, including clinical TNM classification. SPCs were grouped into three 'prognostic groups' based on 5-year relative survival of these cancers as first primary cancer. Kaplan-Meier survival curves were generated and hazard ratios were estimated using Cox regression, adjusted for a number of variables and treating diagnosis of SPC as a time-dependent variable.
The total number of first melanoma patients was 28,716 followed by 3,202 (11.1%) SPCs, 1/3 of which had a second melanoma while 2/3 had other SPCs. Among men diagnosed at age over 70 years, who survived at least 10 years, 31.4% had SPC. HRs (95% CI) for survival increased systematically from the reference rate of 1.00 (no SPC) to 1.59 (1.35-1.87) with SPC of good prognosis (78.6% of SPCs) to 3.49 (2.58-4.72) of moderate prognosis (12.0%) and to 7.93 (5.50-11.44) of poor prognosis (9.4%). In patients without SPC, the HRs increased to 2.62 (2.02-3.39) with any nodal metastases and to 5.88 (4.57-7.57) with any distant metastases compared to patients without local or distant metastases.
The data showed that SPCs are an increasingly common negative prognostic factor for melanoma. Future attempts to improve melanoma survival need to target SPCs.
恶性皮肤黑色素瘤患者的生存率有所提高，但生存率的提高将导致发生第二原发性癌症（SPC）的可能性增加。SPC可能会对生存率产生不利影响。我们对不同类型SPC患者的生存率进行了量化，并与已知的转移性疾病不良预后指标进行了比较。
从瑞典癌症登记处获取2003年至2015年黑色素瘤和任何SPC的数据，包括临床TNM分类。根据这些癌症作为第一原发性癌症的5年相对生存率，将SPC分为三个“预后组”。生成Kaplan-Meier生存曲线，并使用Cox回归估计风险比，对多个变量进行调整，并将SPC的诊断视为时间依赖性变量。
首次诊断为黑色素瘤的患者总数为28716例，随后有3202例（11.1%）发生SPC，其中1/3为第二例黑色素瘤，2/3为其他SPC。在70岁以上诊断出且至少存活10年的男性中，31.4%患有SPC。生存率的风险比（95%可信区间）从无SPC的参考率1.00系统地增加到预后良好的SPC（占SPC的78.6%）的1.59（1.35 - 1.87），预后中等的SPC（12.0%）的3.49（2.58 - 4.72），以及预后不良的SPC（9.4%）的7.93（5.50 - 11.44）。在无SPC的患者中，与无局部或远处转移的患者相比，有任何淋巴结转移的患者风险比增加到2.62（2.02 - 3.39），有任何远处转移的患者风险比增加到5.88（4.57 - 7.57）。
数据表明，SPC是黑色素瘤越来越常见的不良预后因素。未来提高黑色素瘤生存率的尝试需要针对SPC。
