Conditional Survival After Surgical Treatment of Melanoma: An Analysis of the Surveillance, Epidemiology, and End Results Database
Conditional Survival After Surgical Treatment of Melanoma: An Analysis of the Surveillance, Epidemiology, and End Results Database
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DOI：
10.1245/s10434-010-0965-8
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发表时间：
2010-06-01
影响因子：
3.7
通讯作者：
Habermann, Elizabeth B.
中科院分区：
文献类型：
--
作者：
Rueth, Natasha M.;Groth, Shawn S.;Habermann, Elizabeth B.
皮肤黑色素瘤手术治疗后的生存曲线很大程度上受到早期死亡的影响。因此，生存估计可能会误导长期癌症幸存者。我们检查了条件生存（CS）在预测黑色素瘤长期生存方面是否更准确。我们使用监测、流行病学和最终结果数据库（1992-2005）来识别接受黑色素瘤手术治疗的患者。我们纳入了 T2-T4 疾病且淋巴结状态已知的患者。患者被分为低风险（T2-3N0M0）和高风险（T4N0M0 或 T2-4N1-3M0）类别。我们将 CS 定义为以随访中生存到某一点为条件的特定时间估计值，并以年生存率为条件计算了 10 年癌症特异性生存曲线。我们使用 Cox 比例风险回归模型 (alpha = 0.05) 调整潜在的混杂因素。共有 8647 名患者符合纳入标准（低风险，5987 名 [69.2%]；高风险，2660 名 [30.8%]）。诊断时，低风险患者的 10 年生存率明显更高（低风险，79.6%；高风险，41.2%；P < 0.001）。根据 CS 分析，生存差异一直持续到治疗后 8 年，之后低风险组 (95.4%) 和高风险组 (91.7%) 的 10 年癌症特异性生存率不再存在显着差异 (P = 0.51)。多变量分析表明，年龄、性别、部位和溃疡（生存的初始预测因素）在 8 年生存后不再具有预测性。对于黑色素瘤手术治疗后生存 8 年的患者，CS 数据与传统使用的估计值不一致。我们的研究结果对患者咨询具有重要意义，因为高风险黑色素瘤幸存者在治疗 8 年后可能不需要比低风险幸存者更密集的监测。
Survival curves following surgical treatment of cutaneous melanoma are heavily influenced by early deaths. Therefore, survival estimates may be misleading for long-term cancer survivors. We examined whether conditional survival (CS) is more accurate in predicting long-term melanoma survival.We used the Surveillance, Epidemiology, and End Results database (1992-2005) to identify patients who underwent surgical treatment for melanoma. We included patients with T2-T4 disease and with known nodal status. Patients were stratified into low-risk (T2-3N0M0) and high-risk (T4N0M0 or T2-4N1-3M0) categories. We defined CS as time-specific estimates conditioned on living to a certain point in follow-up, and calculated 10-year cancer-specific survival curves conditioned on annual survival. We adjusted for potential confounders using a Cox proportional hazards regression model (alpha = 0.05).A total of 8647 patients met inclusion criteria (low-risk, 5987 [69.2%]; high-risk, 2660 [30.8%]). At diagnosis, low-risk patients had a significantly better 10-year survival rate (low-risk, 79.6%; high-risk, 41.2%; P < 0.001). On CS analysis, survival differences remained until 8 years after treatment, after which 10-year cancer-specific survival rates were no longer significantly different (P = 0.51) for low-risk (95.4%) and high-risk (91.7%) groups. Multivariate analysis demonstrated that age, gender, location, and ulceration (initial predictors of survival) were no longer predictive after 8 years of survival.For patients who survive 8 years after surgical treatment of melanoma, CS data become discordant with traditionally used estimates. Our findings have important implications for patient counseling, as high-risk melanoma survivors may require no more intensive surveillance than low-risk survivors 8 years after treatment.