Sun exposure and mortality from melanoma
Sun exposure and mortality from melanoma
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DOI：
10.1093/jnci/dji019
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发表时间：
2005-02-02
期刊：
影响因子：
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通讯作者：
Barnhill, R
中科院分区：
文献类型：
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作者：
Berwick, M;Armstrong, BK;Barnhill, R
背景黑色素瘤发病率和生存率在地理和时间上都呈正相关。日光性弹性组织变性是皮肤日光损伤的组织学指标，也与黑色素瘤生存率呈正相关。尽管这些观察结果提高了阳光照射增加黑色素瘤存活率的可能性，但它们可以通过黑色素瘤的发病率和早期检测之间的关联来解释。因此，我们评估了皮肤筛查措施与皮肤黑色素瘤死亡之间的关系。方法：病例受试者（n = 528）从一个基于人群的研究皮肤黑色素瘤进行了跟踪平均超过5年。在面对面访谈和组织病理学和组织学参数（即，日光性弹性组织变性、Breslow厚度和有丝分裂）。使用竞争风险模型计算黑色素瘤的死亡风险（风险比[HR]，95%置信区间[CI]）。所有统计学检验均为双侧检验。结果如下：晒伤、间歇性高强度日晒、皮肤过敏史和日光性弹性组织变性与黑色素瘤死亡呈显著负相关。黑色素瘤厚度、有丝分裂、溃疡和头颈部的解剖位置与黑色素瘤死亡有统计学显著正相关。在多变量竞争风险分析中，皮肤意识（有与无，HR = 0.5，95% CI = 0.3至0.9，P = 0.022）和日光性弹性组织变性（存在与不存在，HR = 0.4，95%CI = 0.2至0.8，P = 0.009）与黑色素瘤死亡有强烈的独立相关性，以及头部和颈部的位置，这些也与死亡独立相关。结论：阳光照射与黑色素瘤的生存率增加有关。
Background. Melanoma incidence and survival are positively associated, both geographically and temporally. Solar elastosis, a histologic indicator of cutaneous sun damage, has also been positively associated with melanoma survival. Although these observations raise the possibility that sun exposure increases melanoma survival, they could be explained by an association between incidence and early detection of melanoma. We therefore evaluated the association between measures of skin screening and death from cutaneous melanoma. Methods: Case subjects (n = 528) from a population-based study of cutaneous melanoma were followed for an average of more than 5 years. Data, including measures of intermittent sun exposure, perceived awareness of the skin, skin self-screening, and physician screening, were collected during in-person interviews and review of histopathology and histologic parameters (i.e., solar elastosis, Breslow thickness, and mitoses) for all of the lesions. Competing risk models were used to compute risk of death (hazard ratios [HRs], with 95% confidence intervals [CIs]) from melanoma. All statistical tests were two-sided. Results: Sunburn, high intermittent sun exposure, skin awareness histories, and solar elastosis were statistically significantly inversely associated with death from melanoma. Melanoma thickness, mitoses, ulceration, and anatomic location on the head and neck were statistically significantly positively associated with melanoma death. In a multivariable competing risk analysis, skin awareness (with versus without, HR = 0.5, 95% CI = 0.3 to 0.9, P = .022) and solar elastosis (present versus absent, HR = 0.4, 95% CI = 0.2 to 0.8, P = .009) were strongly and independently associated with melanoma death after adjusting for Breslow thickness, mitotic index, and head and neck location, which were also independently associated with death. Conclusions: Sun exposure is associated with increased survival from melanoma.