Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.
Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
JAMA Dermatol. 2021 Feb 1;157(2):166-173. doi: 10.1001/jamadermatol.2020.5032.
Although regression is commonly observed in cutaneous melanoma, it is uncertain whether it is associated with patient prognosis.
To determine whether histologically confirmed regression was associated with better or worse survival in patients with primary cutaneous melanoma.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data from 2 large cohorts of adults (one in the Netherlands and the other in Australia) with histologically proven, stage 1 and 2 primary, invasive cutaneous melanoma with known regression status treated between 2000 and 2014, with median follow-up times of 4.5 and 11.1 years for the Dutch and Australian cohorts, respectively. For the Dutch patients, population-based data from PALGA, the Dutch Pathology Registry, were used, and follow-up data were retrieved from the Netherlands Cancer Registry. For the Australian patients, data from the database of a large, specialized melanoma treatment center were used.
Multivariable Cox proportional hazards analyses were performed per cohort to assess recurrence-free survival (RFS) and overall survival (OS), and subgroup analyses according to Breslow thickness category and melanoma subtype were performed.
A total of 17 271 Dutch patients and 4980 Australian patients were included. In both cohorts, survival outcomes were better for patients with disease regression. For Dutch patients, the hazard ratio (HR) for those with disease regression was 0.55 (95% CI, 0.48-0.63; P < .001) for RFS and 0.87 (95% CI, 0.79-0.96; P = .004) for OS; for the Australian patients, the HR was 0.61 (95% CI, 0.52-0.72; P < .001) for RFS and 0.73 (95% CI, 0.64-0.84; P < .001) for OS. Subgroup analyses showed that the presence of regression improved RFS within thin and intermediate Breslow thickness melanomas in both cohorts. For patients with superficial spreading melanoma (SSM) subtype, regression improved RFS and OS in both cohorts. For Dutch patients with SSM, the HR for those with disease regression was 0.54 (95% CI, 0.46-0.63; P < .001) for RFS and 0.86 (95% CI, 0.76-0.96; P = .009) for OS; for the Australian patients with SSM, the HR was 0.67 (95% CI, 0.52-0.85; P = .001) for RFS and 0.72 (95% CI, 0.59-0.88; P = .001) for OS.
In 2 large patient cohorts from 2 different continents, regression was a favorable prognostic factor for patients with stage 1 and 2 melanomas, especially in those with thin and intermediate thickness tumors and those with SSM subtype.
尽管皮肤黑色素瘤中经常观察到消退，但尚不确定其是否与患者预后相关。
确定组织学证实的消退是否与原发性皮肤黑色素瘤患者的生存改善或恶化相关。
设计、地点和参与者：这项队列研究分析了来自两个大型成人队列的数据（一个在荷兰，另一个在澳大利亚），这些队列均包含组织学证实的、分期为 1 期和 2 期的、侵袭性原发性、有已知消退状态的、接受过治疗的、浸润性皮肤黑色素瘤患者，这些患者均于 2000 年至 2014 年之间接受治疗，荷兰队列和澳大利亚队列的中位随访时间分别为 4.5 年和 11.1 年。对于荷兰患者，使用了荷兰病理学注册处 PALGA 的基于人群的数据，从荷兰癌症登记处检索了随访数据。对于澳大利亚患者，使用了一个大型、专门的黑色素瘤治疗中心的数据库。
对每个队列进行多变量 Cox 比例风险分析，以评估无复发生存率（RFS）和总生存率（OS），并根据 Breslow 厚度类别和黑色素瘤亚型进行亚组分析。
共纳入了 17271 名荷兰患者和 4980 名澳大利亚患者。在两个队列中，有疾病消退的患者的生存结局更好。对于荷兰患者，疾病消退的患者的风险比（HR）为 0.55（95%CI，0.48-0.63；P<0.001），用于 RFS，0.87（95%CI，0.79-0.96；P=0.004），用于 OS；对于澳大利亚患者，HR 为 0.61（95%CI，0.52-0.72；P<0.001），用于 RFS，0.73（95%CI，0.64-0.84；P<0.001），用于 OS。亚组分析表明，在两个队列中，消退在薄和中等 Breslow 厚度黑色素瘤中均改善了 RFS。对于浅表扩散性黑色素瘤（SSM）亚型的患者，消退在两个队列中均改善了 RFS 和 OS。对于荷兰的 SSM 患者，疾病消退的 HR 为 0.54（95%CI，0.46-0.63；P<0.001），用于 RFS，0.86（95%CI，0.76-0.96；P=0.009），用于 OS；对于澳大利亚的 SSM 患者，HR 为 0.67（95%CI，0.52-0.85；P=0.001），用于 RFS，0.72（95%CI，0.59-0.88；P=0.001），用于 OS。
在来自两个不同大陆的 2 个大型患者队列中，消退是 1 期和 2 期黑色素瘤患者的有利预后因素，尤其是在那些薄型和中型肿瘤以及 SSM 亚型的患者中。
