Sasson Daniel C, Smetona John T, Parsaei Yassmin, Papageorge Marianna, Ariyan Stephan, Olino Kelly, Clune James
Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, USA.
Division of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, USA.
Cureus. 2023 Feb 7;15(2):e34742. doi: 10.7759/cureus.34742. eCollection 2023 Feb.
Objective In this study, we aimed to compare the clinical outcomes between older and younger patients with melanoma and to evaluate for differences in tumor genetic makeup that might explain differences in clinical behavior between older and younger cohorts. Materials and methods A consecutive sample of patients diagnosed with melanoma at a single institution from 1984 to 2019 was categorized by age into younger, middle, and older cohorts. Tumor characteristics, melanoma-specific survival, and recurrence-free survival were assessed while accounting for differential follow-up and death from other causes using Kaplan-Meier analysis with log-rank testing. Results A total of 4378 patients were included in the study. Older patients presented with a higher incidence of T3 and T4 tumors, and a lower incidence of T1 tumors (p<0.001). The same group of patients had a lower nodal positivity at any given Breslow thickness (p<0.01). Melanoma-specific survival was lower for older patients with T2 tumors (p=0.046). There was no difference in recurrence-free survival among all age groups and tumor thicknesses (p>0.05). For patients with a given genetic profile, the melanoma-specific survival and recurrence-free survival were equivalent across ages. BRAF was the most common driver in the younger group, while NRAS and other mutations increased in prevalence as age rose. Conclusions Older adults have decreased melanoma-specific survival for T2 tumors and lower nodal positivity, suggesting a different pattern of metastatic progression. The mutational drivers of cutaneous melanoma change with age and may play a role in the different metastatic progression as well as the differential melanoma-specific survival across all age cohorts.
目的 在本研究中，我们旨在比较老年和年轻黑色素瘤患者的临床结局，并评估肿瘤基因组成的差异，这些差异可能解释老年和年轻队列之间临床行为的差异。材料与方法 1984年至2019年在单一机构诊断为黑色素瘤的患者连续样本按年龄分为年轻、中年和老年队列。评估肿瘤特征、黑色素瘤特异性生存率和无复发生存率，同时使用对数秩检验的Kaplan-Meier分析考虑不同的随访情况和其他原因导致的死亡。结果 本研究共纳入4378例患者。老年患者T3和T4肿瘤的发病率较高，T1肿瘤的发病率较低（p<0.001）。同一组患者在任何给定的Breslow厚度下淋巴结阳性率较低（p<0.01）。T2肿瘤的老年患者黑色素瘤特异性生存率较低（p=0.046）。所有年龄组和肿瘤厚度的无复发生存率无差异（p>0.05）。对于具有给定基因谱的患者，各年龄组的黑色素瘤特异性生存率和无复发生存率相当。BRAF是年轻组中最常见的驱动因素，而NRAS和其他突变的患病率随年龄增长而增加。结论 老年人T2肿瘤的黑色素瘤特异性生存率降低，淋巴结阳性率较低，提示转移进展模式不同。皮肤黑色素瘤的突变驱动因素随年龄变化，可能在不同的转移进展以及所有年龄队列中黑色素瘤特异性生存差异中起作用。
