Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.
Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden.
BMC Cancer. 2021 Oct 19;21(1):1123. doi: 10.1186/s12885-021-08845-x.
Favorable survival in malignant cutaneous melanoma (melanoma) has increased the likelihood of second primary cancer (SPC). We assess the influence of patient characteristics at diagnosis of first melanoma and the type of SPC (second melanoma and other SPC) on overall survival.
We used the Swedish Cancer Registry data to assess overall survival in melanoma for the period 1990 to 2015. Kaplan-Meier curves were plotted and hazard ratios (HRs) were estimated with Cox regression models by considering SPC diagnosis as a time-dependent variable.
A total of 46,726 patients were diagnosed with melanoma, and 15.3% of them developed SPC, among which, two thirds were other SPCs. Second melanomas were diagnosed early (31% during the first year) compared to non-melanoma SPCs (9.5%). Survival for women with second melanoma or other SPC (56 and 21% alive after 25 years of follow-up, respectively) exceeded the male rates (21 and 10%, respectively) but all these figures were lower than for females (60% alive) or males (48%) without SPC. Time dependent analysis showed vastly increased HRs for cancer types that are fatal also as first cancers, but SPC-specific HRs remained relatively uniform, irrespective of SPC diagnosed soon or late after first melanoma. In early-onset melanoma, SPC diagnosis after 10 years may not negatively influence overall survival.
As the overall survival of patients with many types of SPCs is unfavorable, advice about health lifestyle should benefit smoking patients and early detection methods may be recommended for SPCs of the breast, prostate and colorectum.
恶性皮肤黑色素瘤（黑色素瘤）的生存状况较好，增加了第二原发癌（SPC）的可能性。我们评估了首次黑色素瘤诊断时患者特征和 SPC 类型（第二黑色素瘤和其他 SPC）对总生存的影响。
我们使用瑞典癌症登记处的数据评估了 1990 年至 2015 年期间黑色素瘤的总生存情况。通过将 SPC 诊断作为一个时间相关变量，绘制 Kaplan-Meier 曲线并使用 Cox 回归模型估计风险比（HR）。
共有 46726 名患者被诊断患有黑色素瘤，其中 15.3%的患者发生了 SPC，其中三分之二为其他 SPC。与非黑色素瘤 SPC 相比，第二黑色素瘤的诊断较早（31%在第一年）。女性的第二黑色素瘤或其他 SPC（分别在 25 年随访后 56%和 21%存活）的生存情况优于男性（分别为 21%和 10%），但这些数字均低于无 SPC 的女性（60%存活）或男性（48%存活）。时间依赖性分析显示，作为首发癌症也是致命的癌症类型的 HR 大大增加，但 SPC 特异性 HR 相对保持不变，无论 SPC 是在首次黑色素瘤后 10 年内还是较晚诊断。在早发性黑色素瘤中，SPC 在 10 年后的诊断可能不会对总生存产生负面影响。
由于许多类型的 SPC 的总体生存状况不佳，因此关于健康生活方式的建议可能对吸烟患者有益，并且可能建议使用早期检测方法来检测乳腺癌、前列腺癌和结直肠癌的 SPC。
