Liszewski Walter, Stewart Jacob R, Vidal Nahid Y, Demer Addison M
Department of Dermatology, Northwestern University, Chicago, Illinois.
Department of Preventative Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, Chicago, Illinois.
Dermatol Surg. 2022 May 1;48(5):486-491. doi: 10.1097/DSS.0000000000003430. Epub 2022 Mar 15.
Previous studies examining melanoma biopsy technique have not demonstrated an effect on overall survival.
To examine overall survival of patients with cutaneous melanoma diagnosed by shave, punch, incisional, or excisional techniques from the National Cancer Database (NCDB).
Melanoma data from the 2004 to 2016 NCDB data set were analyzed. A Cox proportional hazards model was constructed to assess the risk of 5-year all-cause mortality.
In total, 42,272 cases of melanoma were reviewed, with 27,899 (66%) diagnosed by shave biopsy, 8,823 (20.9%) by punch biopsy, and 5,550 (13.1%) by incisional biopsy. Both the univariate and multivariate analyses demonstrated that tumors diagnosed by incisional biopsy had significantly (p = .001) lower overall 5-year survival compared with shave techniques (hazard ratio [HR] = 1.140, 95% confidence interval [CI] 1.055 to 1.231). We found no difference (p = .109) between shave and punch biopsy techniques (HR 1.062, 95% CI 0.987-1.142) or between punch and incisional techniques (HR 1.074, 95% CI 0.979-1.177, p = .131).
Incisional biopsies were associated with decreased overall 5-year survival in the NCDB. No difference was observed between shave and punch biopsy techniques. These findings support current melanoma management guidelines.
既往关于黑色素瘤活检技术的研究未显示其对总生存期有影响。
通过美国国家癌症数据库（NCDB）研究采用削除活检、钻孔活检、切开活检或切除活检技术诊断的皮肤黑色素瘤患者的总生存期。
分析2004年至2016年NCDB数据集中的黑色素瘤数据。构建Cox比例风险模型以评估5年全因死亡率风险。
共纳入42272例黑色素瘤病例，其中27899例（66%）通过削除活检诊断，8823例（20.9%）通过钻孔活检诊断，5550例（13.1%）通过切开活检诊断。单因素和多因素分析均显示，与削除活检相比，切开活检诊断的肿瘤5年总生存率显著降低（p = 0.001）（风险比[HR]=1.140，95%置信区间[CI]为1.055至1.231）。我们发现削除活检与钻孔活检技术之间（p = 0.109）或钻孔活检与切开活检技术之间（HR = 1.074，95% CI为0.979至1.177，p = 0.131）无差异。
在NCDB中，切开活检与5年总生存率降低相关。削除活检与钻孔活检技术之间未观察到差异。这些发现支持当前的黑色素瘤管理指南。
