Di Carlo Veronica, Estève Jacques, Johnson Christopher, Girardi Fabio, Weir Hannah K, Wilson Reda J, Minicozzi Pamela, Cress Rosemary D, Lynch Charles F, Pawlish Karen S, Rees Judith R, Coleman Michel P, Allemani Claudia
Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Université Claude Bernard, Hospices Civils de Lyon, Service de Biostatistique, Lyon Cedex 03, France.
JNCI Cancer Spectr. 2020 Sep 14;4(6):pkaa078. doi: 10.1093/jncics/pkaa078. eCollection 2020 Dec.
Survival from metastatic cutaneous melanoma is substantially lower than for localized disease. Treatments for metastatic melanoma have been limited, but remarkable clinical improvements have been reported in clinical trials in the last decade. We described the characteristics of US patients diagnosed with cutaneous melanoma during 2001-2013 and assessed trends in short-term survival for distant-stage disease.
Trends in 1-year net survival were estimated using the Pohar Perme estimator, controlling for background mortality with life tables of all-cause mortality rates by county of residence, single year of age, sex, and race for each year 2001-2013. We fitted a flexible parametric survival model on the log-hazard scale to estimate the effect of race on the hazard of death because of melanoma and estimated 1-year net survival by race.
Only 4.4% of the 425 915 melanomas were diagnosed at a distant stage, cases diagnosed at a distant stage are more commonly men, older patients, and African Americans. Age-standardized, 1-year net survival for distant-stage disease was stable at approximately 43% during 2001-2010. From 2010 onward, survival improved rapidly, reaching 58.9% (95% confidence interval = 56.6% to 61.2%) for patients diagnosed in 2013. Younger patients experienced the largest improvement. Survival for distant-stage disease increased in both Blacks and Whites but was consistently lower in Blacks.
One-year survival for distant-stage melanoma improved during 2001-2013, particularly in younger patients and those diagnosed since 2010. This improvement may be a consequence of the introduction of immune-checkpoint-inhibitors and other targeted treatments for metastatic and unresectable disease. Persistent survival inequalities exist between Blacks and Whites, suggesting differential access to treatment.
转移性皮肤黑色素瘤患者的生存率远低于局限性疾病患者。过去，转移性黑色素瘤的治疗方法有限，但在过去十年的临床试验中已报告了显著的临床改善。我们描述了2001 - 2013年期间被诊断为皮肤黑色素瘤的美国患者的特征，并评估了远处转移期疾病的短期生存趋势。
使用波哈尔·佩尔梅估计器估计1年净生存率趋势，通过2001 - 2013年每年按居住县、单一年龄、性别和种族划分的全因死亡率生命表控制背景死亡率。我们在对数风险尺度上拟合了一个灵活的参数生存模型，以估计种族对黑色素瘤死亡风险的影响，并按种族估计1年净生存率。
在425915例黑色素瘤中，仅4.4%在远处转移期被诊断，远处转移期诊断的病例更常见于男性、老年患者和非裔美国人。按年龄标准化，2001 - 2010年期间远处转移期疾病的1年净生存率稳定在约43%。从2010年起，生存率迅速提高，2013年诊断的患者达到58.9%（95%置信区间 = 56.6%至61.2%）。年轻患者的改善最大。远处转移期疾病的生存率在黑人和白人中均有所提高，但黑人的生存率始终较低。
2001 - 2013年期间远处转移期黑色素瘤的1年生存率有所提高，特别是在年轻患者和2010年以后诊断的患者中。这种改善可能是由于引入了免疫检查点抑制剂和其他针对转移性和不可切除疾病的靶向治疗。黑人和白人之间持续存在生存不平等，表明治疗机会存在差异。
