Tod Bianca, Esterhuizen Tonya, Visser Willem, Kotze Maritha, Bowcock Anne, Schneider Johann, Burger Henriette
Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
J Skin Cancer. 2025 Jan 23;2025:4779587. doi: 10.1155/jskc/4779587. eCollection 2025.
Acral melanoma (AM) is the most common type of melanoma arising in people with skin of color. AM is often diagnosed late and associated with poor outcomes. Melanoma outcomes are also impacted by socioeconomic status. Although uncommon, AM is a public health concern in South Africa because of its epidemiology and association with health access issues, which predispose to late diagnosis. South African patients are managed based on staging systems and treatment guidelines developed for other populations. This cohort study aimed to determine the survival outcomes in a cohort of South African AM patients and how these were associated with demographic, clinical, pathological, and management data. The study included patients diagnosed at a referral hospital between 1 January 2010 and 31 December 2021. Analysis occurred in 2022 and 2023. The main outcomes of interest were survival time in months (overall and progression-free, OS and PFS). Survival outcomes were analyzed using Kaplan-Meier survival curves. Survival probabilities were compared between subgroups using log-rank tests. Univariate and multivariable analyses were performed using the Cox proportional hazards models to assess factors associated with survival. Ninety-one patients were included in the analysis. After a median follow-up of 28 months (range: 0-151 months), 48 patients (52.7%) had died. The 3- and 5-year survival rates for the entire cohort were 64.8% and 56.0% respectively. Notably, the OS and PFS were not affected by the population group ( value = 0.628, not significant). The examination of OS and PFS by the clinical stage group demonstrated proportional hazard. Although SLNB comprised a small group, the results appear to be prognostically valid, specifically for OS. The results indicate that the AJCC eighth edition staging is broadly applicable to AM in this population; however, a rigorous comparison was not possible. SLNB appears to be prognostically valid. No difference in survival outcomes by population group was shown.
肢端黑色素瘤（AM）是有色人种中最常见的黑色素瘤类型。AM通常诊断较晚，且预后较差。黑色素瘤的预后也受到社会经济地位的影响。尽管不常见，但由于其流行病学特征以及与医疗可及性问题的关联（这易导致诊断延迟），AM在南非仍是一个公共卫生问题。南非患者的治疗是基于为其他人群制定的分期系统和治疗指南。这项队列研究旨在确定一组南非AM患者的生存结局，以及这些结局与人口统计学、临床、病理和治疗管理数据之间的关联。该研究纳入了2010年1月1日至2021年12月31日期间在一家转诊医院确诊的患者。分析在2022年和2023年进行。主要关注的结局是生存时间（以月为单位，包括总生存期和无进展生存期，即OS和PFS）。使用Kaplan-Meier生存曲线分析生存结局。使用对数秩检验比较亚组之间的生存概率。使用Cox比例风险模型进行单变量和多变量分析，以评估与生存相关的因素。91名患者纳入分析。中位随访28个月（范围：0 - 151个月）后，48名患者（52.7%）死亡。整个队列的3年和5年生存率分别为64.8%和56.0%。值得注意的是，总生存期和无进展生存期不受人群组的影响（ 值 = 0.628，无统计学意义）。按临床分期组对总生存期和无进展生存期进行检查显示存在比例风险。尽管前哨淋巴结活检（SLNB）的患者数量较少，但结果在预后方面似乎是有效的，特别是对于总生存期。结果表明，美国癌症联合委员会（AJCC）第八版分期在该人群中广泛适用于肢端黑色素瘤；然而，无法进行严格的比较。前哨淋巴结活检在预后方面似乎是有效的。未显示人群组之间生存结局存在差异。
