手术拒绝行为对黑色素瘤患者总生存期的影响：一项综合分析
Impact of Surgical Refusal on Overall Survival in Patients With Melanoma: A Comprehensive Analysis.
作者信息
Popp Reed, Savaliya Bansi P, Raikot Swathi R, Ahmed Syeda Hoorulain, Shekouhi Ramin, Bowers Jade, Popp Kyle, Sukniam Kulkaew B, Kowkabany Gabrielle, Jimenez Paola Berrios, Mubarak Fatima, Ekpeh Esinam P, Bansal Shivam, Sharan Seema, Manaise Harsheen K, Gabriel Emmanuel M
机构信息
University of Florida College of Medicine, Gainesville, FL, U.S.A.;
Mayo Clinic, Rochester, MN, U.S.A.
出版信息
Anticancer Res. 2025 Mar;45(3):1063-1070. doi: 10.21873/anticanres.17493.
BACKGROUND/AIM: Surgery is the primary treatment for melanoma, but some patients refuse it, potentially affecting survival. This study examines demographic and clinical factors associated with surgery refusal to inform targeted interventions.
PATIENTS AND METHODS
We conducted a retrospective cohort study using the National Cancer Database (NCDB) to analyze factors linked to surgery refusal in melanoma patients. Demographic, clinical, and treatment characteristics were compared using Pearson Chi-square and Wilcoxon Rank Sum tests.
RESULTS
Among 1,048,575 melanoma patients considered for surgery, 605 (0.1%) refused. Those who refused were older (mean age 75.8 years), had more comorbidities, and were more likely to be racial minorities or socioeconomically disadvantaged (<0.001). Survival analysis showed a lower overall survival rate in the refusal group, with 66.0% alive at follow-up compared to 78.3% in the non-refusal group.
CONCLUSION
Surgery refusal in melanoma patients is associated with advanced age, frailty, and socioeconomic disadvantages, including racial minority status and lower income. Addressing these barriers may improve treatment acceptance and survival outcomes.
背景/目的：手术是黑色素瘤的主要治疗方法，但一些患者拒绝手术，这可能会影响生存。本研究探讨与拒绝手术相关的人口统计学和临床因素，以指导有针对性的干预措施。
患者与方法
我们利用国家癌症数据库（NCDB）进行了一项回顾性队列研究，以分析黑色素瘤患者拒绝手术的相关因素。使用Pearson卡方检验和Wilcoxon秩和检验比较人口统计学、临床和治疗特征。
结果
在1,048,575例考虑手术的黑色素瘤患者中，605例（0.1%）拒绝手术。拒绝手术的患者年龄较大（平均年龄75.8岁），合并症更多，更有可能是少数族裔或社会经济地位不利者（<0.001）。生存分析显示，拒绝手术组的总生存率较低，随访时66.0%存活，而非拒绝手术组为78.3%。
结论
黑色素瘤患者拒绝手术与高龄、身体虚弱以及社会经济不利因素有关，包括少数族裔身份和低收入。解决这些障碍可能会提高治疗接受度和生存结果。
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