Long-Term Outcomes of Nonmelanoma Skin Cancer

描述(申请人提供)：非黑色素瘤皮肤癌是最常见的恶性肿瘤，发病率超过所有非皮肤恶性肿瘤的总和。治疗的传统目标是切除原发癌症并防止其复发，这是一个在治疗后五年前无法充分评估的长期结果。对于大多数肿瘤，许多治疗方法可以防止复发，尽管治疗费用各不相同，但现有数据不足以在治疗方法中进行循证选择。我们收集并跟踪了一组连续的非黑色素瘤皮肤癌(NMSC)患者，以确定他们的短期、患者报告的结果。我们了解到，两种治疗方法在成本上差异很大，在不同的环境中使用也不同，但在短期结果上却是相似的，包括生活质量。该项目将在以前工作的基础上，通过确定包括肿瘤复发在内的长期结果来进行。目标明确、目标明确。通过比较治疗后肿瘤的长期复发率和生活质量来确定非黑色素瘤皮肤癌的治疗效果。这项应用提出了一项前瞻性的纵向研究，研究对象是在诊断为NMSC时收集的一组患者。队列包括1999-2000年在两个大型皮肤科诊所诊断为新的原发NMSC的全部1545名患者。在这个项目中，我们将比较三种最常见的治疗方法，肿瘤电切术和刮治术、切除和莫氏手术的结果。主要结果是治疗后至少五年肿瘤复发；次要结果是与皮肤相关的生活质量。我们推测，电切和刮除后肿瘤复发率最高，切除和Mohs手术后复发率相似。数据的主要来源是患者检查、医疗记录和患者对调查的反应。分析。混合效应广义线性模型将被用来模拟治疗对结果的影响，调整患者、肿瘤和临床医生的因素，这些因素可能已经影响了治疗后五年的肿瘤复发和生活质量。多变量COX比例风险模型也将被用来探索首次肿瘤复发检测时间的分布。与公共卫生的相关性。鉴于NMSC的高患病率，治疗的有效性很重要，但人们对此知之甚少。该项目将在有高保真基线临床和患者报告数据的有价值的连续队列中评估治疗在预防肿瘤复发和改善生活质量方面的有效性。结果将通过允许更直接地基于证据的治疗选择来通知临床医生。这些结果也将为计划NMSC不同治疗方法的对照试验提供基础，以指导关于这种常见肿瘤资源使用的决定。

DESCRIPTION (provided by applicant): Nonmelanoma skin cancer is the most frequent malignancy, with an incidence exceeding that of all noncutaneous malignancies combined. The conventional goal of therapy is removal of the primary cancer and prevention of its recurrence, a long-term outcome that cannot be assessed adequately before five years after therapy. For most tumors, many therapies can prevent recurrence, and although therapies vary in cost, existing data are insufficient to permit evidence-based choices among therapies. We have assembled and followed a consecutive cohort of patients with nonmelanoma skin cancer (NMSC) to determine their short- term, patient-reported outcomes. We have learned that two therapies that vary widely in cost and are used differently in different settings nonetheless have similar in short-term outcomes, including quality-of-life. This project will build on this previous work, by determining long-term outcomes, including tumor recurrence. Objective and Specific Aims. To determine the effectiveness of therapies for nonmelanoma skin cancer by comparing long-term tumor recurrence rates and quality of life after treatments. This application proposes a prospective longitudinal study of a cohort of patients assembled at the time of diagnosis of NMSC. The cohort consists of all 1545 patients with new primary NMSC diagnosed in 1999-2000 at two large dermatology practices. In this project we will compare outcomes from the three most common therapies, tumor destruction with electrodessication & curettage, excision, and Mohs surgery. The primary outcome is tumor recurrence at a minimum of five years after therapy; a secondary outcome is skin-related quality of life. We hypothesize that tumor recurrence will be highest after electrodessication & curettage, and similar after excision and Mohs surgery. Principal sources of data are patient examination, medical records, and patient responses to surveys. Analyses. Mixed effects generalized linear models will be used to model the effect of treatment on outcomes, adjusting for patient, tumor, and clinician factors that might likely have affected tumor recurrence and quality of life at five years after therapy. Multivariate Cox proportional hazards models will also be used to explore the distribution of time to detection of first tumor recurrence. Relevance to Public Health. Given the high prevalence of NMSC, effectiveness of therapies is important, but poorly understood. This project will evaluate effectiveness of therapies in preventing tumor recurrence and improving quality of life in a valuable consecutive cohort on whom high-fidelity baseline clinical and patient-reported data are available. Results will inform clinicians by permitting therapeutic choices that are more directly based on evidence. The results will also provide a basis for planning controlled trials of different treatments of NMSC, to guide decisions about the use of resources for this common tumor.