Roush G C, Nordlund J J, Forget B, Gruber S B, Kirkwood J M
Yale University School of Medicine, New Haven, Connecticut 06520.
Prev Med. 1988 May;17(3):273-9. doi: 10.1016/0091-7435(88)90003-5.
In the determination of risk for melanoma, relatively little is known about the possible independence of two important predictors, total nevi and clinically dysplastic nevi. From a study conducted in Sydney, Australia [see J. J. Nordlund et al., Cancer Res. 45, 1855-1861 (1985)], 246 cases of melanoma (excluding 7% of targeted patients with a history of melanoma in a first-degree relative) were compared with 134 nonmelanoma controls. Participants had been examined by a dermatologist and an oncologist. Logistic regression analysis was used and included an age-sex interaction term in computing all estimates of relative risk in this report. Relative risk for melanoma in those with 16+ total nevi was significantly elevated at 1.8 but declined to a statistically nonsignificant level of 1.2 (95% confidence limit (CL): 0.7, 2.0) after adjustment for dysplastic nevi. In contrast, relative risk for melanoma in those with any dysplastic nevi was 7.6 (95% CL: 3.6, 16.0) but was maintained at a similarly elevated and statistically significant level of 7.7 (95% CL: 3.5, 17.1) after adjustment for total nevi. These patterns were even more evident in the younger half of the study population. The analyses suggest that much of the association between TN and nonfamilial melanoma is explained by the presence of dysplastic nevi and, conversely, they imply that dysplastic nevi represent a clinically distinct, qualitative disorder rather than simply a quantitative disorder wherein dysplastic nevi stem merely from an increase in total nevi. The dysplastic nevus syndrome accounts for 32% of all nonfamilial melanomas.
在黑色素瘤风险的判定中，对于两个重要预测指标——痣的总数和临床发育异常痣——可能的独立性，人们了解得相对较少。在澳大利亚悉尼进行的一项研究中[见J. J. 诺德伦德等人，《癌症研究》45, 1855 - 1861 (1985)]，将246例黑色素瘤病例（不包括7%有一级亲属黑色素瘤病史的目标患者）与134例非黑色素瘤对照进行了比较。参与者均接受了皮肤科医生和肿瘤学家的检查。使用了逻辑回归分析，并且在本报告计算所有相对风险估计值时纳入了年龄 - 性别交互项。痣总数为16个及以上者患黑色素瘤的相对风险显著升高至1.8，但在对发育异常痣进行调整后降至1.2（95%置信区间(CL)：0.7, 2.0），该水平在统计学上无显著意义。相比之下，有任何发育异常痣者患黑色素瘤的相对风险为7.6（95% CL：3.6, 16.0），但在对痣总数进行调整后维持在同样升高且具有统计学显著意义的7.7（95% CL：3.5, 17.1）水平。这些模式在研究人群中年龄较小的那一半中更为明显。分析表明，痣总数与非家族性黑色素瘤之间的大部分关联可由发育异常痣的存在来解释，反之，这意味着发育异常痣代表一种临床上不同的定性疾病，而非仅仅是一种定量疾病，即发育异常痣仅仅源于痣总数的增加。发育异常痣综合征占所有非家族性黑色素瘤的32%。
