Department of Surgery, Zuyderland Medical Center, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands.
Department of Medical Oncology, Zuyderland Medical Center, Sittard, The Netherlands.
Target Oncol. 2024 Sep;19(5):735-745. doi: 10.1007/s11523-024-01090-9. Epub 2024 Aug 24.
Patient demographics and shared decision making might influence the choice of adjuvant therapy for stage III melanoma.
To identify factors for treatment selection of patients diagnosed with stage III melanoma to better understand current treatment decisions and improve further treatment counseling.
Data from 2007 patients diagnosed with stage III melanoma, between December 2018 and 2021, sourced from the Dutch Cancer Registry, were analyzed.
Among the cohort, 48.7% received no therapy, 45.8% received checkpoint inhibition, and 5.5% received targeted therapy (TT). Patients foregoing therapy were significantly older [67.0 years (range 53.0-77.0) vs. 62.0 year (range 52.0-72.0)], had poorer performance scores (PS), and higher Charlson Comorbidity Index scores compared to those receiving therapy (p < 0.001). Patients undergoing therapy had significantly higher median Breslow thickness (3.3 mm vs. 2.2 mm) and higher prevalence of ulceration (49.9% vs. 38.1%). Those with connective tissue disease and/or congestive heart disease were more likely to receive TT [odds ration (OR) 8.1; 95% confidence interval (CI) 1.7-37.6 and OR 9.3; 95% CI 1.2-72.2, respectively]. Median treatment time among strata for disease recurrence was 4.26 months (3.69-4.82) for immunotherapy and 3.1 months (0.85-5.36) for TT (p = 0.298). Patients who developed recurrent disease were equal across treatment types (p = 0.656). The number of patients with grade 3 complications was different for each treatment type [immunotherapy: 17.8% vs. TT: 37.3% (p < 0.001)].
Age, PS, and Breslow thickness seem to influence adjuvant treatment decisions. Clinicians' preference for immunotherapy might play a role in counseling BRAF-positive patients for adjuvant therapy, this however, cannot be confirmed in this dataset. Overall, only a small proportion of patients completed adjuvant treatment.
患者人口统计学特征和共同决策可能会影响 III 期黑色素瘤辅助治疗的选择。
确定诊断为 III 期黑色素瘤患者的治疗选择因素，以更好地了解当前的治疗决策，并进一步改善治疗咨询。
对 2007 例 2018 年 12 月至 2021 年间在荷兰癌症登记处诊断为 III 期黑色素瘤的患者数据进行了分析。
在队列中，48.7%的患者未接受治疗，45.8%的患者接受了检查点抑制治疗，5.5%的患者接受了靶向治疗（TT）。与接受治疗的患者相比，未接受治疗的患者年龄明显更大[67.0 岁（范围 53.0-77.0）vs. 62.0 岁（范围 52.0-72.0）]，表现状态（PS）更差，Charlson 合并症指数评分更高（p<0.001）。接受治疗的患者的中位 Breslow 厚度明显更高（3.3mm 与 2.2mm），溃疡发生率更高（49.9%与 38.1%）。患有结缔组织疾病和/或充血性心力衰竭的患者更有可能接受 TT[比值比（OR）8.1；95%置信区间（CI）1.7-37.6 和 OR 9.3；95%CI 1.2-72.2]。在疾病复发的分层中，免疫治疗的中位治疗时间为 4.26 个月（3.69-4.82），TT 的中位治疗时间为 3.1 个月（0.85-5.36）（p=0.298）。在治疗类型中，复发疾病患者的数量相等（p=0.656）。每种治疗类型的 3 级并发症患者数量不同[免疫治疗：17.8%vs.TT：37.3%（p<0.001）]。
年龄、PS 和 Breslow 厚度似乎会影响辅助治疗决策。临床医生对免疫疗法的偏好可能会在为 BRAF 阳性患者提供辅助治疗咨询时发挥作用，但在本数据集内无法确认。总体而言，只有一小部分患者完成了辅助治疗。
