比较头颈部黑色素瘤与身体黑色素瘤患者的特征并预测其生存情况：一项基于人群的研究。
Comparing the characteristics and predicting the survival of patients with head and neck melanoma versus body melanoma: a population-based study.
机构信息
Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, No. 88, Jiefang Road, Hangzhou, 310009, China.
Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China.
出版信息
BMC Cancer. 2021 Apr 16;21(1):420. doi: 10.1186/s12885-021-08105-y.
BACKGROUND
Previous studies reported cutaneous melanoma in head and neck (HNM) differed from those in other regions (body melanoma, BM). Individualized tools to predict the survival of patients with HNM or BM remain insufficient. We aimed at comparing the characteristics of HNM and BM, developing and validating nomograms for predicting the survival of patients with HNM or BM.
METHODS
The information of patients with HNM or BM from 2004 to 2015 was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. The HNM group and BM group were randomly divided into training and validation cohorts. We used the Kaplan-Meier method and multivariate Cox models to identify independent prognostic factors. Nomograms were developed via the rms and dynnom packages, and were measured by the concordance index (C-index), the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and calibration plots.
RESULTS
Of 70,605 patients acquired, 21% had HNM and 79% had BM. The HNM group contained more older patients, male sex and lentigo maligna melanoma, and more frequently had thicker tumors and metastases than the BM group. The 5-year cancer-specific survival (CSS) and overall survival (OS) rates were 88.1 ± 0.3% and 74.4 ± 0.4% in the HNM group and 92.5 ± 0.1% and 85.8 ± 0.2% in the BM group, respectively. Eight variables (age, sex, histology, thickness, ulceration, stage, metastases, and surgery) were identified to construct nomograms of CSS and OS for patients with HNM or BM. Additionally, four dynamic nomograms were available on web. The internal and external validation of each nomogram showed high C-index values (0.785-0.896) and AUC values (0.81-0.925), and the calibration plots showed great consistency.
CONCLUSIONS
The characteristics of HNM and BM are heterogeneous. We constructed and validated four nomograms for predicting the 3-, 5- and 10-year CSS and OS probabilities of patients with HNM or BM. These nomograms can serve as practical clinical tools for survival prediction and individual health management.
背景
先前的研究报告称，头颈部皮肤黑素瘤（HNM）与身体其他部位的黑素瘤（BM）不同。用于预测 HNM 或 BM 患者生存的个体化工具仍然不足。我们旨在比较 HNM 和 BM 的特征，开发并验证预测 HNM 或 BM 患者生存的列线图。
方法
从 2004 年至 2015 年，从监测、流行病学和最终结果（SEER）数据库中获取 HNM 或 BM 患者的信息。HNM 组和 BM 组被随机分为训练和验证队列。我们使用 Kaplan-Meier 方法和多变量 Cox 模型来识别独立的预后因素。通过 rms 和 dynnom 包开发列线图，并通过一致性指数（C 指数）、接收者操作特征（ROC）曲线的曲线下面积（AUC）和校准图进行测量。
结果
共获得 70605 例患者，21%为 HNM，79%为 BM。HNM 组中年龄较大、男性和恶性雀斑样痣黑素瘤患者更多，肿瘤厚度和转移更频繁。HNM 组的 5 年癌症特异性生存率（CSS）和总生存率（OS）分别为 88.1±0.3%和 74.4±0.4%，BM 组分别为 92.5±0.1%和 85.8±0.2%。有 8 个变量（年龄、性别、组织学、厚度、溃疡、分期、转移和手术）被确定用于构建 HNM 或 BM 患者的 CSS 和 OS 列线图。此外，还可以在网络上获得四个动态列线图。每个列线图的内部和外部验证均显示出较高的 C 指数值（0.785-0.896）和 AUC 值（0.81-0.925），校准图显示出很好的一致性。
结论
HNM 和 BM 的特征具有异质性。我们构建并验证了四个用于预测 HNM 或 BM 患者 3 年、5 年和 10 年 CSS 和 OS 概率的列线图。这些列线图可以作为预测生存和个体健康管理的实用临床工具。
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