Wu Xinxin, Silberstein Peter T
College of Medicine, Creighton University School of Medicine, Omaha, USA.
Oncology, Creighton University School of Medicine, Omaha, USA.
Cureus. 2024 Nov 22;16(11):e74247. doi: 10.7759/cureus.74247. eCollection 2024 Nov.
Spindle cell melanoma (SCM) is a rare melanoma subtype characterized histologically by atypical, spindled, malignant melanocytes. SCM often presents in older patients and lacks typical cytologic markers, complicating diagnosis and frequently leading to advanced disease upon presentation. While some studies have documented SCM incidence, none have thoroughly examined the demographic, socioeconomic, and treatment factors influencing survival outcomes.
This study aims to investigate how demographic and clinical factors affect overall survival outcomes in SCM, providing updated data on demographic, socioeconomic, and tumor-related characteristics and treatment patterns.
This retrospective cohort study analyzed histologically confirmed spindle cell melanoma and mixed spindle cell melanoma cases diagnosed between 2004 and 2021. Patient demographic, socioeconomic, and clinical factors were collected, and multivariate Cox regression analysis was performed to determine the effects on overall survival.
Among 9,210 SCM cases, most were White patients (97.5%), male (65.2%), and located in metropolitan areas (85.7%). Males were more likely to receive treatment at academic centers and have higher comorbidity scores. The average age at diagnosis was 67.3 years (SD±15.1). SCM in head and neck regions showed a worse prognosis compared to extremity melanomas. Surgical intervention, received by 84.9% of patients, was associated with improved overall survival. The minority of patients who received radiation and chemotherapy (13.2% and 3.3%, respectively) were linked to increased mortality risk.
Age, sex, insurance status, treatment facility type, tumor location, and stage significantly influence SCM survival outcomes. The findings suggest that SCM's prognosis is closely tied to demographic and clinical characteristics, similar to other melanoma subtypes, supporting standard treatment protocols with surgical intervention as the primary approach. This large-scale study leverages comprehensive NCDB data, contributing to the literature gap in SCM's treatment and management.
梭形细胞黑色素瘤（SCM）是一种罕见的黑色素瘤亚型，组织学上表现为非典型的、梭形的恶性黑色素细胞。SCM常见于老年患者，缺乏典型的细胞学标志物，这使得诊断变得复杂，并常常导致疾病在初诊时即已进展。虽然一些研究记录了SCM的发病率，但尚无研究全面考察影响生存结局的人口统计学、社会经济和治疗因素。
本研究旨在调查人口统计学和临床因素如何影响SCM的总生存结局，提供有关人口统计学、社会经济和肿瘤相关特征以及治疗模式的最新数据。
这项回顾性队列研究分析了2004年至2021年间经组织学确诊的梭形细胞黑色素瘤和混合性梭形细胞黑色素瘤病例。收集了患者的人口统计学、社会经济和临床因素，并进行多因素Cox回归分析以确定对总生存的影响。
在9210例SCM病例中，大多数为白人患者（97.5%）、男性（65.2%），且位于大都市地区（85.7%）。男性更有可能在学术中心接受治疗，且合并症评分更高。诊断时的平均年龄为67.3岁（标准差±15.1）。与肢体黑色素瘤相比，头颈部的SCM预后更差。84.9%的患者接受了手术干预，这与总生存改善相关。接受放疗和化疗的少数患者（分别为13.2%和3.3%）与死亡风险增加有关。
年龄、性别、保险状况、治疗机构类型、肿瘤位置和分期显著影响SCM的生存结局。研究结果表明，与其他黑色素瘤亚型类似，SCM的预后与人口统计学和临床特征密切相关，支持以手术干预为主要方法的标准治疗方案。这项大规模研究利用了全面的国家癌症数据库（NCDB）数据，填补了SCM治疗和管理方面的文献空白。
