Department of Surgery, University of Toronto, Toronto, ON, Canada.
Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Ann Surg Oncol. 2020 Aug;27(8):2927-2948. doi: 10.1245/s10434-020-08265-4. Epub 2020 Apr 4.
Few studies have examined outcomes in immunosuppressed patients who develop melanoma. The purpose of this study is to compare survival in immunosuppressed patients who developed melanoma with that in patients with melanoma who are not immunosuppressed.
Immunosuppressed patients were defined as having solid organ transplant, lymphoma, leukemia, or human immunodeficiency virus prior to diagnosis of melanoma. Patients with cutaneous melanoma with and without immunosuppression were identified retrospectively from the Ontario Cancer Registry (2007-2015) and linked with administrative databases to identify demographics, treatment, and outcomes. Immunosuppressed patients were matched with non-immunosuppressed patients based on age at diagnosis, sex, birth year, stage at diagnosis, and propensity score. The primary outcome was overall survival. Multivariable Cox proportional hazard regression was used to identify factors associated with survival.
Baseline characteristics were well balanced in 218 immunosuppressed patients matched to 436 controls. Of the patients, 186 (28.4%) were female, and median age at melanoma diagnosis was 69 (interquartile range, IQR 59-78) years. Three-year overall survival (OS) was 65% for immunosuppressed patients and 79% for non-immunosuppressed patients. Melanoma was the leading cause of death for both groups. On multivariable analysis, immunosuppression was associated with increased mortality [hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.30-2.23]. Adequate treatment (HR 0.36, 95% CI 0.22-0.58) and dermatologist visits either before (HR 0.52, 95% CI 0.36-0.73) or after (HR 0.61, 95% CI 0.41-0.90) melanoma diagnosis were associated with improved OS.
Immunosuppressed patients who develop melanoma have worse outcomes when matched to non-immunosuppressed patients. This decrease in survival appears related to the underlying condition rather than diagnosis of melanoma.
鲜有研究探讨过发生黑色素瘤的免疫抑制患者的结局。本研究旨在比较免疫抑制患者和非免疫抑制黑色素瘤患者的生存情况。
在诊断黑色素瘤之前，将接受过实体器官移植、淋巴瘤、白血病或人类免疫缺陷病毒治疗的患者定义为免疫抑制患者。通过安大略省癌症登记处（2007-2015 年）回顾性地识别有和无免疫抑制的皮肤黑色素瘤患者，并与行政数据库链接以确定人口统计学、治疗和结局。根据诊断时的年龄、性别、出生年份、诊断时的分期和倾向评分，将免疫抑制患者与非免疫抑制患者进行匹配。主要结局是总生存。多变量 Cox 比例风险回归用于确定与生存相关的因素。
在与 436 名对照匹配的 218 名免疫抑制患者中，基线特征得到了很好的平衡。患者中 186 名（28.4%）为女性，黑色素瘤诊断时的中位年龄为 69 岁（四分位距，IQR 59-78 岁）。免疫抑制患者的 3 年总生存率（OS）为 65%，而非免疫抑制患者的 79%。黑色素瘤是两组患者的主要死亡原因。多变量分析显示，免疫抑制与死亡率增加相关[风险比（HR）1.70，95%置信区间（CI）1.30-2.23]。充分的治疗（HR 0.36，95%CI 0.22-0.58）和皮肤科医生的就诊（无论是在黑色素瘤诊断之前（HR 0.52，95%CI 0.36-0.73）还是之后（HR 0.61，95%CI 0.41-0.90））与 OS 改善相关。
与非免疫抑制黑色素瘤患者匹配时，发生黑色素瘤的免疫抑制患者的结局更差。这种生存下降似乎与潜在疾病有关，而不是黑色素瘤的诊断。
