黑色素瘤过度诊断：我们知道什么？我们能做什么？

Melanoma overdiagnosis: What do we know and what do we do?

机构信息

MBChB, FRCPA, Senior Lecturer, Faculty of Medicine, The University of Queensland, Brisbane, Qld; Distinguished Visiting Professor TUMS, Department of Dermatology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

BMath, BSc, BSc (Hons), Intercalated MD, PhD, Faculty of Medicine, The University of Queensland, Brisbane, Qld.

出版信息

Aust J Gen Pract. 2024 Sep;53(9):612-616. doi: 10.31128/AJGP-02-24-7176.

DOI:10.31128/AJGP-02-24-7176

PMID:39226593

Abstract

BACKGROUND

Melanoma overdiagnosis occurs when melanomas, not destined to cause morbidity or death in a patient's lifetime, are identified and treated.

OBJECTIVE

This study considers the causes and magnitude of melanoma overdiagnosis in Australia. We also speculate about a possible benefit of overdiagnosis in Australia; namely, a reduction in excess deaths in the geographical areas where melanoma is diagnosed most frequently.

DISCUSSION

Overdiagnosis can arguably be mitigated by factors that reduce the number of lesions treated for each melanoma identified. Data from the Australian Cancer Atlas show that there is a reduction in excess deaths from melanoma in geographical areas where diagnostic rates are higher (Pearson correlation coefficient r=-0.5978, 95% CI: -0.6243 to -0.5699, P<0.0001); this being the strongest inverse correlation observed among the 20 cancer types in the Atlas. Is early diagnosis of actual life-threatening melanomas in these geographical regions impacting survival? Further research is planned.

摘要

背景

当黑色素瘤在患者有生之年不会导致发病或死亡的情况下被发现和治疗时，就会出现黑色素瘤过度诊断。

目的

本研究考虑了澳大利亚黑色素瘤过度诊断的原因和程度。我们还推测了过度诊断在澳大利亚可能存在的益处，即在诊断黑色素瘤最频繁的地理区域减少超额死亡人数。

讨论

通过减少每个被诊断出的黑色素瘤所治疗的病变数量，可以减轻过度诊断的问题。澳大利亚癌症图谱的数据显示，在诊断率较高的地理区域，黑色素瘤的超额死亡人数有所减少（皮尔逊相关系数 r=-0.5978，95%置信区间：-0.6243 至-0.5699，P<0.0001）；这是图谱中 20 种癌症类型中观察到的最强负相关。在这些地理区域，早期诊断出实际危及生命的黑色素瘤是否会影响生存率？计划进行进一步的研究。