Long-Term Outcomes of Nonmelanoma Skin Cancer

描述（由申请方提供）：非黑色素瘤皮肤癌是最常见的恶性肿瘤，其发病率超过所有非皮肤恶性肿瘤的总和。传统的治疗目标是切除原发性癌症并预防其复发，这是一种长期结果，在治疗后五年内无法充分评估。对于大多数肿瘤，许多治疗方法可以预防复发，尽管治疗方法的成本各不相同，但现有数据不足以在治疗方法中进行循证选择。我们已经收集并随访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。我们已经了解到，两种治疗方法的成本差异很大，在不同的环境中使用的方式也不同，但在短期结果方面却相似，包括生活质量。该项目将建立在以前的工作基础上，通过确定长期结果，包括肿瘤复发。目的和具体目标。通过比较治疗后的长期肿瘤复发率和生活质量，确定非黑色素瘤皮肤癌治疗的有效性。 本申请提出了对诊断NMSC时聚集的患者队列的前瞻性纵向研究。该队列由1999-2000年在两个大型皮肤科诊所诊断的所有1545例新发原发性NMSC患者组成。在这个项目中，我们将比较三种最常见的治疗方法的结果，电切和刮除，切除和莫氏手术的肿瘤破坏。主要结果是治疗后至少五年的肿瘤复发;次要结果是皮肤相关的生活质量。我们假设，肿瘤复发率将是最高的电切和刮除后，切除和莫氏手术后相似。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用于模拟治疗对结局的影响，调整可能影响治疗后5年肿瘤复发和生活质量的患者、肿瘤和临床医生因素。还将使用多变量考克斯比例风险模型探索至首次肿瘤复发检测时间的分布。与公共卫生相关。鉴于NMSC的高患病率，治疗的有效性很重要，但了解甚少。该项目将在一个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，该队列具有高保真基线临床和患者报告数据。结果将通过允许更直接基于证据的治疗选择来告知临床医生。结果还将为计划NMSC不同治疗的对照试验提供基础，以指导有关这种常见肿瘤资源使用的决策。

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.