Interferon Alfa-2b or not 2b? Significant differences exist in the decision-making process between melanoma patients who accept or decline high-dose adjuvant interferon Alfa-2b treatment.
Interferon Alfa-2b or not 2b? Significant differences exist in the decision-making process between melanoma patients who accept or decline high-dose adjuvant interferon Alfa-2b treatment.
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干扰素 Alfa-2b 还是非 2b？
DOI：
10.1111/j.1524-4725.2007.33001.x
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Chen,SuephyC
中科院分区：
文献类型：
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作者：
Bramlette,TracyB;Lawson,DavidH;Washington,CarlV;Veledar,Emir;Johns,BarryR;Brisman,StaceyF;Abramova,Liana;Chen,SuephyC
背景厚（Breslow>4 mm）原发性黑色素瘤和/或区域淋巴结转移的患者肿瘤复发的风险很高。高剂量辅助干扰素 (IFN) alfa-2b 可将无复发生存率和总生存率改善 ≤10%，且具有显着毒性。 目的 目的是确定哪些预后因素和患者特征对于决定接受 IFN 治疗具有重要意义。 方法 在 781 名接受前哨淋巴结 (SLN) 活检的患者中，781 例中有 135 例 (17.3%) SLN 阳性或厚黑色素瘤，并被告知复发/疾病相关死亡率≥50% 的风险，并提供 IFN。电话调查描述了患者决定接受 IFN 背后的原因。结果 135 名接受者中有 60 名 (45%) 决定服用 IFN alfa-2b，而 135 名接受者中有 75 名 (55%) 拒绝接受。女性（OR，2.4；95% CI，1.17-5.03；p=.017）和阳性 SLN 状态（OR，2.2；95% CI，1.01-4.97；p=.048）与选择 IFN 的患者密切相关。干扰素的接受者更年轻，受医生的影响更大，并且受抑郁和副作用的影响较小（全部 p<.05）。衰退者更担心与家庭和社会生活的紧张关系 (p<.05)。 结论 性别和 SLN 阳性是高危黑色素瘤患者接受 IFN 治疗的预测因素。医生对黑色素瘤患者治疗决策过程的深入了解可以指导患者克服这种困难的疾病。
BACKGROUNDPatients with thick (Breslow >4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High‐dose adjuvant interferon (IFN) alfa‐2b offers ≤10% improvement in relapse‐free survival and overall survival with significant toxicity.OBJECTIVEThe objective was to determine which prognostic factors and patient characteristics are significant in the decision to undergo IFN therapy.METHODSOf 781 patients who underwent sentinel lymph node (SLN) biopsy, 135 of 781 (17.3%) had positive SLN or thick melanomas and were informed of a ≥50% risk of recurrence/disease‐related mortality and offered IFN. Telephone surveys delineated reasons behind patients' decisions to accept IFN.RESULTSAcceptors, 60 of 135 (45%), decided to take IFN alfa‐2b whereas 75 of 135 (55%) declined. Being female (OR, 2.4; 95% CI, 1.17–5.03;p=.017) and positive SLN status (OR, 2.2; 95% CI, 1.01–4.97;p=.048) were strongly associated with patients who chose IFN. Acceptors of IFN were younger, more influenced by physicians, and less affected by depression and side effect profile (p<.05 for all). Decliners were more concerned by strained relationships with family and social life (p<.05).CONCLUSIONSGender and positive SLN were predictive of high‐risk melanoma patients' acceptance of IFN treatment. Physician insight into melanoma patients' therapeutic decision‐making process can guide patients through this difficult disease.