Neff Corey, Price Mackenzie, Ballard Christine Ann Pittman, Cioffi Gino, Liu Zhen, Walsh Rabina, Barnholtz-Sloan Jill S, Walsh Kyle M, Salama April K S, Anders Carey K, Fecci Peter E, Ostrom Quinn T
Baylor College of Medicine, Durham, NC, United States.
National Institutes of Health, United States.
Cancer Epidemiol Biomarkers Prev. 2025 Jun 23. doi: 10.1158/1055-9965.EPI-24-1212.
Development of new melanoma therapies has increased survival, and more patients are living to develop brain metastasis (BrM). Identifying those at increased risk of BrM is of significant public health importance, and our objective was to assess the relationship between atopy and survival or reduced BrM cumulative incidence (CI) in melanoma.
This retrospective study was conducted in individuals (≥65 years) in linked Surveillance, Epidemiology and End Results and Medicare data. History of atopy diagnosed prior to melanoma was ascertained using ICD-9/ICD-10 codes. Associations between atopy, CI of BrM and overall survival were assessed using cox proportional hazards models to estimate hazard ratios (HR) and p-values.
A total of 23,508 cutaneous melanoma cases were identified. Overall, 6.1% developed BrM, and 38% had history of atopy. Atopy was associated with a 18% decrease in death (p<0.001). Among those without metastasis at diagnosis, atopy decreased BrM CI by 16% (p=0.006). Among those with metastasis at diagnosis (any site), only those who received checkpoint inhibitors had a suggestive but non-significant survival with atopy.
Atopy confers improved survival and decreased BrM CI. History of atopy in the elderly may identify those with more robust immune function that may be more responsive to treatment.
Elderly individuals with prior diagnosis of atopy had significantly improved survival and decreased incidence of BrM as compared to individuals without atopy. This suggests that history of atopy may identify a subgroup within melanoma with improved response to treatment and a more robust immune system.
新型黑色素瘤疗法的发展提高了生存率，越来越多的患者存活下来并发生脑转移（BrM）。识别BrM风险增加的患者具有重大的公共卫生意义，我们的目标是评估特应性与黑色素瘤患者生存率或降低的BrM累积发病率（CI）之间的关系。
这项回顾性研究纳入了与监测、流行病学和最终结果以及医疗保险数据相关联的65岁及以上个体。使用ICD-9/ICD-10编码确定黑色素瘤诊断之前的特应性病史。使用Cox比例风险模型评估特应性、BrM的CI与总生存率之间的关联，以估计风险比（HR）和p值。
共识别出23,508例皮肤黑色素瘤病例。总体而言，6.1%的患者发生了BrM，38%有特应性病史。特应性与死亡风险降低18%相关（p<0.001）。在诊断时无转移的患者中，特应性使BrM的CI降低了16%（p=0.006）。在诊断时已有转移（任何部位）的患者中，只有接受检查点抑制剂治疗的患者特应性与生存率之间存在提示性但不显著的关联。
特应性可改善生存率并降低BrM的CI。老年人的特应性病史可能表明这些患者具有更强的免疫功能，可能对治疗更敏感。
与无特应性的个体相比，先前诊断为特应性的老年人的生存率显著提高，BrM的发病率降低。这表明特应性病史可能识别出黑色素瘤患者中对治疗反应更好且免疫系统更强的一个亚组。
