皮肤黑色素瘤的亚型分类很重要。
Subtyping Cutaneous Melanoma Matters.
作者信息
El Sharouni Mary-Ann, van Diest Paul Johannes, Witkamp Arjen Joost, Sigurdsson Vigfús, van Gils Carla Henrica
机构信息
Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
出版信息
JNCI Cancer Spectr. 2020 Oct 23;4(6):pkaa097. doi: 10.1093/jncics/pkaa097. eCollection 2020 Dec.
BACKGROUND
Our aim was to investigate the role of melanoma subtype on survival and focus on the effects stratified by Breslow thickness and ulceration status.
METHODS
Patients with cutaneous melanoma stage I, II, or III diagnosed between 2000 and 2014 were derived from the Dutch Nationwide Pathology Registry and overall survival data from the Netherlands Cancer Registry. Patients were followed until 2018. Using multivariable Cox proportional hazards models, hazard ratios were calculated for each melanoma subtype, per Breslow thickness category and ulceration status, and adjusted for age, sex, stage, and localization.
RESULTS
A total of 48 361 patients were included: 79.3% had superficial spreading melanoma (SSM), 14.6% nodular melanoma (NM), 5.2% lentigo maligna melanoma, and 0.9% acral lentiginous melanoma (ALM). In the total patient group, using SSM as the reference category, adjusted hazard ratios were 1.06 (95% confidence interval [CI] = 1.01 to 1.12) for NM, 1.02 (95% CI = 0.93 to 1.13) for lentigo maligna melanoma, and 1.26 (95% = CI 1.06 to 1.50) for ALM. Among patients with 1.0 mm or less Breslow thickness and no ulceration, NM showed a twofold increased risk (hazard ratio = 1.96, 95% CI = 1.58 to 2.45) compared with SSM. Compared with 1.0 mm or less SSM without ulceration, the hazard ratio for 1.0 mm or less SSM with ulceration was 1.94 (95% CI = 1.55 to 2.44), and the hazard ratio for 1.0 mm or less NM with ulceration was 3.46 (95% CI = 2.17 to 5.50). NM patients with tumors greater than 1.0 mm did not show worse survival than SSM patients with tumors greater than 1.0 mm.
CONCLUSIONS
In this large nationwide study, ALM patients showed worse survival than SSM patients. Among patients with melanomas that were thin (1.0 mm or less), NM subtype patients also showed worse survival than SSM patients.
背景
我们的目的是研究黑色素瘤亚型对生存的影响，并重点关注按 Breslow 厚度和溃疡状态分层的影响。
方法
2000 年至 2014 年间诊断为 I、II 或 III 期皮肤黑色素瘤的患者来自荷兰全国病理登记处，并获取了荷兰癌症登记处的总生存数据。对患者进行随访至 2018 年。使用多变量 Cox 比例风险模型，计算每种黑色素瘤亚型、每个 Breslow 厚度类别和溃疡状态的风险比，并对年龄、性别、分期和部位进行调整。
结果
共纳入 48361 例患者：79.3% 为浅表扩散性黑色素瘤（SSM），14.6% 为结节性黑色素瘤（NM），5.2% 为恶性雀斑样痣黑色素瘤，0.9% 为肢端雀斑样痣黑色素瘤（ALM）。在整个患者组中，以 SSM 作为参考类别，NM 的调整后风险比为 1.06（9
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