Ramachandran Vignesh, Loya Asad, Phan Kevin
Dermatology, Baylor College of Medicine, Houston, USA.
Medicine, Baylor College of Medicine, Houston, USA.
Cureus. 2020 Feb 9;12(2):e6924. doi: 10.7759/cureus.6924.
Introduction While prior studies have addressed the gender-specific survival of malignant melanoma, such investigation is lacking for melanoma in situ (MIS) and for the sun-exposed head and neck areas. Understanding the role of patient characteristics on disease prognosis is essential in determining optimal patient treatment and follow-up. We conducted a retrospective cohort study of patients diagnosed with MIS of the head and neck to assess the association of gender with long-term survival. Methods First primary cases of MIS diagnosed between 1998 and 2015 were extracted from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. Cox regression analysis adjusting for demographic, tumor, and treatment characteristics was used to evaluate all-cause and cancer-specific mortality risks. Results After adjusting for demographic, tumor, and treatment data, males demonstrated significantly poorer overall survival (hazard ratio [HR] 1.484; 95% confidence interval [CI] 1.332, 1.653; P<0.001) and cancer-specific survival (HR 1.571; 95% CI 1.056, 2.338; P=0.026) compared to their female counterparts. Conclusion Proposed reasons for these findings include gender-based hormonal influence on cancer growth and development, gender-specific health utilization behaviors, and gender-based cosmetic impact of cutaneous malignancies. These findings do have limitations, including its retrospective nature, possible upgrading of MIS diagnoses during the study period, miscoding, and inability to account of lifestyle/modifiable/environmental risk factors. Nevertheless, it suggests a gender-specific survival difference, which may be further investigated and considered as part of clinician awareness, influence patient counseling, and screening for such patients.
引言 虽然先前的研究已经探讨了恶性黑色素瘤患者的性别特异性生存率，但对于原位黑色素瘤（MIS）以及头颈部暴露于阳光下的区域，此类研究尚属空白。了解患者特征对疾病预后的作用对于确定最佳患者治疗和随访至关重要。我们对诊断为头颈部MIS的患者进行了一项回顾性队列研究，以评估性别与长期生存之间的关联。
方法 从美国国立癌症研究所的监测、流行病学和最终结果（SEER）数据库中提取1998年至2015年间诊断的首例原发性MIS病例。使用调整了人口统计学、肿瘤和治疗特征的Cox回归分析来评估全因死亡率和癌症特异性死亡风险。
结果 在调整了人口统计学、肿瘤和治疗数据后，与女性相比，男性的总体生存率（风险比[HR]1.484；95%置信区间[CI]1.332，1.653；P<0.001）和癌症特异性生存率（HR 1.571；95%CI 1.056，2.338；P=0.026）显著较差。
结论 这些发现的可能原因包括基于性别的激素对癌症生长和发展的影响、基于性别的健康利用行为以及皮肤恶性肿瘤基于性别的美容影响。这些发现确实存在局限性，包括其回顾性性质、研究期间MIS诊断可能的升级、编码错误以及无法考虑生活方式/可改变/环境风险因素。然而，它表明了性别特异性的生存差异，这可能需要进一步研究，并作为临床医生意识的一部分加以考虑，影响患者咨询以及对此类患者的筛查。
