Prognostic subclassifications of T1 cutaneous melanomas based on ulceration, tumour thickness and Clark's level of invasion: results of a population-based study from the Swedish Melanoma Register
Prognostic subclassifications of T1 cutaneous melanomas based on ulceration, tumour thickness and Clark's level of invasion: results of a population-based study from the Swedish Melanoma Register
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DOI：
10.1111/bjd.12095
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发表时间：
2013-04-01
影响因子：
10.3
通讯作者：
Lindholm, C.
中科院分区：
文献类型：
--
作者：
Lyth, J.;Hansson, J.;Lindholm, C.
背景薄黑色素瘤的生存率和预后因素在人群中的研究相对较少。这一患者群体占大多数的黑色素瘤诊断在西方国家今天，和更好的预后信息是需要的目的，这项研究的目的是使用既定的预后因素，如溃疡，肿瘤厚度和克拉克的水平，为风险分层的T1皮肤黑色素瘤。瑞典黑色素瘤登记包括瑞典诊断的所有黑色素瘤的97%。总共有13026例T1黑色素瘤患者的临床分期为I期，用于估计黑色素瘤特异性10年和15年死亡率。考克斯回归模型用于进一步生存分析11 165例患者的完整data.Results溃疡，肿瘤厚度和克拉克的浸润水平都显示出显着的，独立的，长期预后信息。结合这些因素，患者可以分为三个风险组：低风险组（T1病例的67.9%），10年黑色素瘤特异性死亡率为1.5%（1.2-1.9%）;中等风险群体（T1病例的28.6%），10年死亡率为6.1%（5.0-7.3%）;高危组（T1病例的3.5%），10年死亡率为15.6%（11.2-21.4%）。高、中危组占T1期黑色素瘤死亡的66%。结论使用基于人群的黑色素瘤登记，结合溃疡、肿瘤厚度和Clark's浸润水平，确定了三个不同的预后亚组。
Background Survival and prognostic factors for thin melanomas have been studied relatively little in population-based settings. This patient group accounts for the majority of melanomas diagnosed in western countries today, and better prognostic information is needed.Objectives The aim of this study was to use established prognostic factors such as ulceration, tumour thickness and Clark's level of invasion for risk stratification of T1 cutaneous melanoma.Methods From 1990 to 2008, the Swedish Melanoma Register included 97% of all melanomas diagnosed in Sweden. Altogether, 13 026 patients with T1 melanomas in clinical stage I were used for estimating melanoma-specific 10- and 15-year mortality rates. The Cox regression model was used for further survival analysis on 11 165 patients with complete data.Results Ulceration, tumour thickness and Clark's level of invasion all showed significant, independent, long-term prognostic information. By combining these factors the patients could be subdivided into three risk groups: a low-risk group (67.9% of T1 cases) with a 10-year melanoma-specific mortality rate of 1.5% (1.2-1.9%); an intermediate-risk group (28.6% of T1 cases) with a 10-year mortality rate of 6.1% (5.0-7.3%); and a high-risk group (3.5% of T1 cases) with a 10-year mortality rate of 15.6% (11.2-21.4%). The high-and intermediate-risk groups accounted for 66% of melanoma deaths within T1.Conclusions Using a population-based melanoma register, and combining ulceration, tumour thickness and Clark's level of invasion, three distinct prognostic subgroups were identified.