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Long-Term Outcomes of Nonmelanoma Skin Cancer

非黑色素瘤皮肤癌的长期结果

基本信息

批准号：
8263226
负责人：
Mary-Margaret Chren
金额：
$ 32.99万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-09-15 至 2012-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8263226
关键词：
Long Term Outcomes Nonmelanoma Skin

项目摘要

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。传统的治疗目标是切除原发性癌症并预防其复发，这是治疗后五年之前无法充分评估的长期结果。对于大多数肿瘤，许多疗法可以预防复发，尽管疗法的成本各不相同，但现有数据不足以允许在疗法中进行基于证据的选择。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、患者报告的结果。我们了解到，两种疗法的成本差异很大，并且在不同环境下使用方式也不同，但短期结果（包括生活质量）却相似。该项目将建立在先前工作的基础上，通过确定长期结果，包括肿瘤复发。客观和具体目标。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。本申请提出了对诊断 NMSC 时聚集的一组患者进行前瞻性纵向研究。该队列由 1999 年至 2000 年在两家大型皮肤科诊所诊断出的所有 1545 名新原发性 NMSC 患者组成。在这个项目中，我们将比较三种最常见疗法的结果，即通过电干燥和刮除术破坏肿瘤、切除术和莫氏手术。主要结局是治疗后至少五年内肿瘤复发；次要结果是与皮肤相关的生活质量。我们假设电热切除和刮宫后肿瘤复发率最高，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果的影响，调整可能影响治疗后五年肿瘤复发和生活质量的患者、肿瘤和临床医生因素。多变量 Cox 比例风险模型也将用于探索检测首次肿瘤复发的时间分布。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。该项目将在一个有价值的连续队列中评估治疗方法在预防肿瘤复发和改善生活质量方面的有效性，这些队列可以获得高保真基线临床和患者报告的数据。结果将告知临床医生，允许更直接地基于证据的治疗选择。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，以指导有关针对这种常见肿瘤的资源使用的决策。