Titus-Ernstoff L, Duray P H, Ernstoff M S, Barnhill R L, Horn P L, Kirkwood J M
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06510.
Cancer Res. 1988 Feb 15;48(4):1016-8.
Risk factors for multiple primary cutaneous melanoma were evaluated in a case-control study. Eight cases of multiple primary melanoma were matched on sex, age, and education to 24 first primary melanoma controls. Risk factors examined in the analysis included pigmentary characteristics, history of sun exposure, and nevi. The importance of histologically dysplastic nevi (DN) and clinically atypical nevi was of particular interest. Single-factor conditional logistic regression analysis showed that first primary melanoma patients with histological DN are at increased risk for a second primary (odds ratio, 6.2; 95% confidence interval, 1.2-33.4). Patients with two or more clinically atypical nevi also have elevated risk for a second primary (odds ratio, 8.8; 95% confidence interval, 1.0-80.7). Two-factor logistic models were used to evaluate the effect of histological DN while controlling singly for all other variables as potential confounders. Odds ratios for the association of histological DN varied from 6.1 to 10.4 when adjusting singly for pigmentary and sun exposure variables. In the two-factor model that included histological and clinical DN, both variables retained marginally significant statistical association with multiple primary melanoma. These results suggest that DN is a marker of increased risk for multiple primary melanoma and suggest that melanoma patients with evidence of DN should be followed closely for the development of additional primaries.
在一项病例对照研究中评估了多发性原发性皮肤黑色素瘤的危险因素。8例多发性原发性黑色素瘤患者在性别、年龄和教育程度上与24例原发性黑色素瘤对照者进行匹配。分析中检测的危险因素包括色素沉着特征、日晒史和痣。组织学发育异常痣（DN）和临床非典型痣的重要性尤其令人关注。单因素条件逻辑回归分析显示，患有组织学DN的原发性黑色素瘤患者发生第二原发性肿瘤的风险增加（优势比，6.2；95%置信区间，1.2 - 33.4）。有两个或更多临床非典型痣的患者发生第二原发性肿瘤的风险也升高（优势比，8.8；95%置信区间，1.0 - 80.7）。使用双因素逻辑模型评估组织学DN的影响，同时单独控制所有其他变量作为潜在混杂因素。在单独调整色素沉着和日晒变量时，组织学DN关联的优势比在6.1至10.4之间变化。在包括组织学和临床DN的双因素模型中，这两个变量与多发性原发性黑色素瘤均保持边缘显著的统计学关联。这些结果表明，DN是多发性原发性黑色素瘤风险增加的一个标志物，提示有DN证据的黑色素瘤患者应密切随访以观察是否发生额外的原发性肿瘤。
