Discordance of pathological thin melanoma thickness and T stage in SEER registry: impacts on clinical management and research directions.
Discordance of pathological thin melanoma thickness and T stage in SEER registry: impacts on clinical management and research directions.
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SEER 登记中病理性薄黑色素瘤厚度与 T 分期不一致：对临床管理和研究方向的影响
DOI：
10.18632/oncotarget.21980
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发表时间：
2017-11-17
期刊：
影响因子：
--
通讯作者：
Li Q
中科院分区：
文献类型：
--
作者：
Wang Z;Li H;Liu X;Bae J;Huang X;Gao Y;Xu X;Guo J;Lu L;Zan T;Li Q
背景超薄黑色素瘤先前已被证明有较高的风险，黑色素瘤特异性死亡率使用SEER数据库。然而，这些改变指南的结论最近受到了厚度错误编码的挑战。本研究的目的是评估仅使用经手术治疗、病理证实和去除不一致病例后的薄黑色素瘤的预后。方法收集1998 - 2012年SEER数据库中经组织学确诊和手术治疗的黑色素瘤患者。排除T分期与肿瘤厚度不一致的受试者。采用Kaplan-Meier曲线、log-rank检验和多因素考克斯比例风险回归模型。结果55,754例患者符合严格的入选标准，但16例（0.02%）患者因T0分期而被排除，803例（1.4%）患者因T0分期与厚度不一致而被排除。因此，54，935例患者进入分析，其中52，751例为LN阴性，2，184例为LN阳性。在总体或LN阴性患者中，观察到较大厚度与死亡率增加的直接剂量效应关系。相反，在LN阳性患者中，T1亚组与T2 mm亚组中的肿瘤表现出相似的生存率。多变量分析显示相同的模式，和显着的相互作用T分期和LN involvement. Further分类T1黑色素瘤成10个相等的0.10毫米增量显示了一个意想不到的“N”形模式的死亡率在总体和LN阴性的恶性黑色素瘤，但不是在LN阳性的黑色素瘤。结论T1-3期肿瘤累及LN的死亡率无差异。需要进行外部和独立的验证研究。
Background Ultrathin melanoma was previously demonstrated to have higher risk for melanoma-specific mortality using SEER database. However, these guideline-changing conclusions has been recently challenged by miscoding of thickness. This present study was performed to assess the prognosis of thin and ultrathin melanoma using only surgically-treated, pathologically confirmed and after removal of discordant cases. Methods Melanoma patients from SEER database who were initially diagnosed with histologically confirmed and surgically treated melanoma from 1998 to 2012 were included. Subjects with discordance between T stage and tumor thickness were excluded. Kaplan-Meier curves, log-rank test and multivariate Cox proportional hazards regression models were used. Results 55,754 patients met the strict inclusion criteria, but 16 (0.02%) and 803 (1.4%) patients were removed due to T0 stage and discordance between T stage and thickness, respectively. Therefore, 54,935 patients entered the analyses, among which 52,751 were LN negative and 2,184 were LN positive. In either overall or LN-negative patients, a straightforward dose-effect relationship of larger thickness with increasing mortality was observed. In contrast, in LN positive patients, the T1 subgroup demonstrated a similar survival with tumors in T2 mm subgroup. Multivariable analysis revealed same pattern, and significant interaction between T stage and LN involvement was found. Further categorizing T1 melanoma into 10 equal 0.10 mm increments demonstrated an unexpected “N”-shaped pattern of mortality in overall and LN negative ultrathin melanoma but not in LN positive melanoma. Conclusions No difference in mortality was observed in T1-3 tumors with LN involvement. External and independent validation studies are warranted.
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DOI：
10.1016/j.jid.2016.05.121
发表时间：
2016-11
期刊：
The Journal of investigative dermatology
影响因子：
--
作者：
Gimotty PA;Shore R;Lozon NL;Whitlock J;He S;Vigneau FD;Dickie L;Elder DE;Xu X;Schwartz AG;Guerry D
通讯作者：
Guerry D
影响因子：
6.5
作者：
Hay, Roderick J.;Johns, Nicole E.;Naghavi, Mohsen
通讯作者：
Naghavi, Mohsen
影响因子：
45.3
作者：
Balch, Charles M.;Gershenwald, Jeffrey E.;Sondak, Vernon K.
通讯作者：
Sondak, Vernon K.
影响因子：
13.8
作者：
Wei, Erin X.;Qureshi, Abrar A.;Han, Jiali;Li, Tricia Y.;Cho, Eunyoung;Lin, Jennifer Y.;Li, Wen-Qing
通讯作者：
Li, Wen-Qing
影响因子：
2.8
作者：
Wang, Yuwei;Zhuo, Changhua;Cai, Guoxiang
通讯作者：
Cai, Guoxiang