State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Gastric and Melanoma Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China.
Dermatol Ther. 2021 Jul;34(4):e14981. doi: 10.1111/dth.14981. Epub 2021 May 24.
To investigate the prognostic significance of time to recurrence (TTR) for overall survival (OS) and survival after recurrence (SAR) in patients with localized or regionally advanced cutaneous melanoma. A total of 731 cutaneous melanoma patients with an initial diagnosis of 8th American Joint Committee on Cancer (AJCC) clinical stage I-III were included in this study. The prognostic factors associated with OS and SAR were estimated through Kaplan-Meier and Cox regression analysis. Of the total cohort, 329 patients (45%) died, and 418 patients (57%) experienced recurrence. The median follow-up and TTR were 55.6 months and 9.6 months, respectively. A total of 141 patients (19%) experienced recurrence in <6 months, and 277 patients (38%) experienced recurrence in ≥6 months. Patients with stage III and positive lymph node dissection (LND) were more common in the early TTR group than in the late TTR group. Both the OS and SAR rates at 5 years and 10 years in the early TTR group were significantly poorer than those in the late TTR group (P < .001 and P = .008, respectively). Furthermore, early TTR, along with truncal tumor, higher TNM stage and therapeutic variables (extended resection, LND and adjuvant therapy), were significant independent predictors of worse OS and SAR in multivariate analysis (all P < .05). Early TTR predicts worse survival and could be considered an independent prognostic factor for patients with localized or regionally advanced cutaneous melanoma. TTR should be evaluated in all patients with recurrence to guide post-recurrence risk stratification and follow-up schedules.
探讨局部或区域性晚期皮肤黑色素瘤患者的无复发生存时间（TTR）对总生存（OS）和复发后生存（SAR）的预后意义。本研究共纳入 731 例初诊为 8 版美国癌症联合委员会（AJCC）临床分期 I-III 期的皮肤黑色素瘤患者。通过 Kaplan-Meier 和 Cox 回归分析估计与 OS 和 SAR 相关的预后因素。在总队列中，329 例（45%）患者死亡，418 例（57%）患者复发。中位随访和 TTR 分别为 55.6 个月和 9.6 个月。共有 141 例（19%）患者在<6 个月内复发，277 例（38%）患者在≥6 个月内复发。早期 TTR 组中 III 期和阳性淋巴结清扫（LND）患者更为常见。早期 TTR 组 5 年和 10 年的 OS 和 SAR 率均明显低于晚期 TTR 组（均 P<.001 和 P=.008）。此外，早期 TTR 与躯干肿瘤、更高的 TNM 分期和治疗变量（扩大切除术、LND 和辅助治疗）一起，在多变量分析中是 OS 和 SAR 较差的独立预测因素（均 P<.05）。早期 TTR 预测生存更差，可被视为局部或区域性晚期皮肤黑色素瘤患者的独立预后因素。应在所有复发患者中评估 TTR，以指导复发后风险分层和随访计划。
