Department of Dermatology, University of California Davis, Sacramento, California, USA.
Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California, USA.
J Eur Acad Dermatol Venereol. 2022 Nov;36(11):2025-2035. doi: 10.1111/jdv.18458. Epub 2022 Aug 23.
Melanoma is one of the most common malignancies during pregnancy. There is debate regarding the impact of pregnancy on the prognosis of melanoma. Recent large population-based studies from the United States are lacking.
To determine the characteristics and survival of women with pregnancy-associated melanoma.
This population-based, retrospective cohort study used California Cancer Registry data linked with state-wide hospitalization and ambulatory surgery data to identify 15-44-year-old female patients diagnosed with melanoma in 1994-2015, including pregnant patients. Multivariable logistic regression compared demographic and clinical characteristics between pregnant and non-pregnant women with melanoma. Multivariable cox proportional hazards regression models assessed melanoma-specific and overall survival.
We identified 13 108 patients, of which 1406 were pregnant. Pregnancy-associated melanoma was more frequent in Hispanic compared to non-Hispanic White women. Melanoma occurring post-partum was associated with greater tumour thickness (2.01-4.00 vs. 0.01-1.00 mm, odds ratio 1.75, 95% confidence interval: 1.03-2.98). There were otherwise no significant differences between pregnant and non-pregnant women. Worse survival was associated with Asian, Black and Native American race/ethnicity (vs. non-Hispanic White), lower neighbourhood socio-economic status, public insurance, tumour site, greater tumour thickness and lymph node involvement, but not pregnancy.
Melanoma occurring post-partum was associated with greater tumour thickness, but pregnancy status did not affect survival after melanoma. Race/ethnicity, socio-economic status and health insurance impacted survival, emphasizing the importance of reducing health disparities.
黑色素瘤是妊娠期间最常见的恶性肿瘤之一。关于妊娠对黑色素瘤预后的影响存在争议。目前缺乏来自美国的大型基于人群的研究。
确定与妊娠相关的黑色素瘤患者的特征和生存情况。
本基于人群的回顾性队列研究使用加利福尼亚癌症登记处的数据，并与全州住院和门诊手术数据相关联，以确定 1994 年至 2015 年间诊断为黑色素瘤的 15-44 岁女性患者，包括妊娠患者。多变量逻辑回归比较了妊娠和非妊娠黑色素瘤患者的人口统计学和临床特征。多变量 Cox 比例风险回归模型评估了黑色素瘤特异性和总体生存率。
我们确定了 13108 名患者，其中 1406 名患者处于妊娠状态。与非西班牙裔白人相比，西班牙裔妊娠相关黑色素瘤更为常见。产后发生的黑色素瘤与更大的肿瘤厚度相关（2.01-4.00 与 0.01-1.00mm，优势比 1.75，95%置信区间：1.03-2.98）。在其他方面，妊娠和非妊娠女性之间没有显著差异。较差的生存与亚洲人、黑人和美洲原住民种族/民族（与非西班牙裔白人相比）、较低的社区社会经济地位、公共保险、肿瘤部位、更大的肿瘤厚度和淋巴结受累有关，但与妊娠无关。
产后发生的黑色素瘤与更大的肿瘤厚度相关，但妊娠状态并不影响黑色素瘤后的生存。种族/民族、社会经济地位和医疗保险影响生存，强调了减少健康差距的重要性。
