Murali Tharani, Schwartz Matthew, Reynolds Adam Z, Luo Li, Ridgeway Grace, Busam Klaus J, Cust Anne E, Anton-Culver Hoda, Gallagher Richard P, Zanetti Roberto, Rosso Stefano, Sacchetto Lidia, Begg Colin B, Orlow Irene, Thomas Nancy E, Berwick Marianne
Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM 87131, United States.
College of Population Health, University of New Mexico, Albuquerque, NM 87131, United States.
JNCI Cancer Spectr. 2025 Jan 3;9(1). doi: 10.1093/jncics/pkaf005.
Sex differences in melanoma are prominent, with female having a significant survival advantage. However, it is unclear why we see this survival advantage. Here, we investigate the relationship between sex, clinicopathologic variables, and melanoma specific survival in 1753 single primary melanomas from patients in the GEM (Genes, Environment, and Melanoma) study. Using Cox proportional hazard models and formal mediation analysis, the effect of sex on survival is explained largely by differences in the clinicopathologic features of tumors at diagnosis. Specifically, we find evidence that 86.5% of the effect of sex on melanoma survival is mediated by differences in age at diagnosis, Breslow thickness, ulceration, mitoses, and site (hazard ratio [HR] = 1.85, P < .001). This analysis indicates that the female survival advantage in melanoma is not primarily due to a direct effect of sex (HR = 1.19, P = .42) but is largely a result of an indirect effect of sex mediated by clinicopathologic features.
黑色素瘤中的性别差异很显著，女性具有明显的生存优势。然而，我们尚不清楚为何会出现这种生存优势。在此，我们在来自GEM（基因、环境与黑色素瘤）研究的1753例单发原发性黑色素瘤患者中，调查性别、临床病理变量与黑色素瘤特异性生存之间的关系。使用Cox比例风险模型和正式的中介分析，性别对生存的影响在很大程度上可由诊断时肿瘤临床病理特征的差异来解释。具体而言，我们发现有证据表明，性别对黑色素瘤生存86.5%的影响是由诊断时的年龄、Breslow厚度、溃疡、核分裂象和部位的差异介导的（风险比[HR]=1.85，P < 0.001）。该分析表明，黑色素瘤中女性的生存优势并非主要归因于性别的直接影响（HR = 1.19，P = 0.42），而是很大程度上是由临床病理特征介导的性别的间接影响所致。
