Thörn M, Pontén F, Bergström R, Sparén P, Adami H O
Department of Surgery, University Hospital, Uppsala, Sweden.
Br J Cancer. 1994 Oct;70(4):743-8. doi: 10.1038/bjc.1994.388.
In Sweden, improvement in survival rates of patients with cutaneous malignant melanoma has counteracted the increase in incidence to produce a moderate rise in mortality. Our aim was to determine the possible impact of drift in diagnostic criteria, earlier diagnosis and changing biological features of the tumours upon trends in survival. We studied a stratified sample of 528 patients diagnosed between 1960 and 1984 in a strictly defined geographical region. No evidence of drift in diagnostic criteria was found. The proportion of patients with invasion level Clark II increased from 3.2% in 1960-64 to 22.5% in 1980-84, the proportion of thin melanomas (< or = 0.75 mm) increased from 9.4% to 31.5% and the tumour thickness decreased significantly between each 5 year period of diagnosis. These changes are most likely the results of earlier diagnosis. However, changes in tumour characteristics have occurred, since the proportion of superficially spreading malignant melanoma increased from 35% in 1960-64 to 51% in 1980-84 and the proportion of acral lentiginous melanoma decreased from 11% to 2%. The proportion of nodular melanomas remained fairly constant. The proportion of tumours with lymphocytic reaction did not change, whereas those with histological regression increased slightly. Proportional hazards analyses showed a significantly lower survival in patients diagnosed in 1960-64 but no apparent trend after 1965. This finding remained after adjustment for all studied clinical and histopathological factors which point towards changes in unmeasured biological features of the disease.
在瑞典，皮肤恶性黑色素瘤患者生存率的提高抵消了发病率的上升，从而使死亡率有适度增长。我们的目的是确定诊断标准的变化、早期诊断以及肿瘤生物学特征的改变对生存趋势可能产生的影响。我们研究了1960年至1984年期间在一个严格界定的地理区域内诊断出的528例患者的分层样本。未发现诊断标准有变化的证据。侵袭水平为克拉克二级的患者比例从1960 - 1964年的3.2%增至1980 - 1984年的22.5%，薄黑色素瘤（≤0.75毫米）的比例从9.4%增至31.5%，并且在每5年的诊断期间肿瘤厚度显著下降。这些变化很可能是早期诊断的结果。然而，肿瘤特征也发生了变化，因为浅表扩散性恶性黑色素瘤的比例从1960 - 1964年的35%增至1980 - 1984年的51%，肢端雀斑样痣黑色素瘤的比例从11%降至2%。结节性黑色素瘤的比例保持相当稳定。有淋巴细胞反应的肿瘤比例没有变化，而有组织学消退的肿瘤比例略有增加。比例风险分析显示，1960 - 1964年诊断出的患者生存率显著较低，但1965年之后没有明显趋势。在对所有研究的临床和组织病理学因素进行调整后，这一发现仍然存在，这表明该疾病未测量的生物学特征发生了变化。
