Long-Term Outcomes of Nonmelanoma Skin Cancer

非黑色素瘤皮肤癌的长期结果

• 批准号: 7087092
• 负责人: Mary-Margaret Chren
• 金额: $ 34.63万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-15 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7087092
• 关键词: clinical research; neoplasm /cancer; quality of life; skin; skin neoplasms; surgery

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.

描述（由申请人提供）：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。传统治疗的目标是去除原发癌并预防其复发，这是一个长期的结果，在治疗后5年之前无法充分评估。对于大多数肿瘤，许多治疗方法都可以预防复发，尽管治疗方法的成本各不相同，但现有的数据不足以让我们在治疗方法中做出基于证据的选择。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、患者报告的预后。我们已经了解到，两种治疗方法在成本上差异很大，在不同的情况下使用不同的方法，但在短期效果上是相似的，包括生活质量。该项目将建立在之前的工作基础上，通过确定包括肿瘤复发在内的长期结果。目标和具体目标。通过比较长期肿瘤复发率和治疗后的生活质量来确定非黑色素瘤皮肤癌治疗的有效性。本应用程序提出了一项前瞻性纵向研究，在诊断NMSC时聚集了一组患者。该队列包括1999-2000年在两个大型皮肤科诊所诊断的所有1545例新的原发性NMSC患者。在这个项目中，我们将比较三种最常见的治疗方法的结果，肿瘤破坏与电干燥和刮除，切除和莫氏手术。主要预后是治疗后至少5年的肿瘤复发；第二个结果是与皮肤相关的生活质量。我们推测电干刮除后肿瘤复发率最高，切除和莫氏手术后肿瘤复发率相似。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用于模拟治疗对结果的影响，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Cox比例风险模型来探索首次肿瘤复发的检测时间分布。与公共卫生相关。鉴于NMSC的高患病率，治疗的有效性很重要，但人们对其了解甚少。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，这些队列中有高保真基线临床和患者报告的数据。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。研究结果还将为规划NMSC不同治疗方法的对照试验提供基础，以指导这种常见肿瘤的资源使用决策。