Department of Surgery, University of Toronto, Toronto, ON, Canada.
Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Ann Surg Oncol. 2021 Jun;28(6):3302-3311. doi: 10.1245/s10434-020-09224-9. Epub 2020 Oct 16.
Melanoma and the immune system are intimately related. However, the association of immunosuppressive medications (ISMs) with survival in melanoma is not well understood. The study evaluated this at a population level.
A cohort of patients with a diagnosis of invasive cutaneous melanoma (2007-2015) was identified from the Ontario Cancer Registry and linked to identify demographics, stage at diagnosis, prescription of immunosuppressive medications (both before and after diagnosis), and outcomes. The demographics of patients with and without prescriptions for ISM were compared. Patients eligible for Ontario's Drug Benefit Plan were included to ensure accurate prescription data. The primary outcome was overall survival. Cox Proportional Hazards Regression models identified factors associated with mortality, including use of ISM as a time-varying covariate.
Of the 4954 patients with a diagnosis of cutaneous melanoma, 1601 had a prescription for ISM. The median age of the patients was 74 years. Overall, 58.4% of the patients were men (60.5% of those without ISM and 54% of those using ISM; p < 0.001). The use of oral immunosuppression was associated with an increased hazard of death (hazard ratio, 5.84; 95% confidence interval, 5.11-6.67; p < 0.0001) when control was used for age, disease stage at diagnosis, anatomic site, comorbidity, and treatment. Other factors associated with death were increasing age, male sex, increased disease stage, truncal location of primary melanoma, and inadequate treatment. In sensitivity analysis with steroid-only ISM use excluded, survival did not differ significantly (p = 0.355).
The use of immunosuppressive steroids for melanoma is associated with worse overall survival. Use of steroids should be limited when possible.
黑色素瘤与免疫系统密切相关。然而，免疫抑制药物（ISMs）与黑色素瘤患者生存的关系尚不清楚。本研究在人群水平上对此进行了评估。
从安大略省癌症登记处确定了 2007 年至 2015 年间患有侵袭性皮肤黑色素瘤的患者队列，并对其进行了联系，以确定人口统计学特征、诊断时的分期、免疫抑制药物的处方（包括诊断前后）以及结局。比较了有和没有 ISM 处方的患者的人口统计学特征。纳入符合安大略省药物福利计划条件的患者，以确保准确的处方数据。主要结局是总生存。Cox 比例风险回归模型确定了与死亡率相关的因素，包括将 ISM 作为时变协变量使用。
在 4954 例皮肤黑色素瘤患者中，有 1601 例患者有 ISM 处方。患者的中位年龄为 74 岁。总体而言，58.4%的患者为男性（无 ISM 患者中为 60.5%，使用 ISM 患者中为 54%；p<0.001）。当对照年龄、诊断时疾病分期、解剖部位、合并症和治疗时，口服免疫抑制的使用与死亡风险增加相关（危险比，5.84；95%置信区间，5.11-6.67；p<0.0001）。与死亡相关的其他因素包括年龄增加、男性、疾病分期增加、原发性黑色素瘤的躯干位置以及治疗不足。在排除仅使用类固醇 ISM 的敏感性分析中，生存差异无统计学意义（p=0.355）。
使用免疫抑制类固醇治疗黑色素瘤与总体生存较差相关。应尽可能限制类固醇的使用。
