发表在12月份Arch Dermatol期刊上的一项研究"Risk and Survival of Cutaneous Melanoma Diagnosed Subsequent to a Previous Cancer"指出,癌症幸存者患皮肤黑色素瘤(CM)的风险较高,黑色素瘤是皮肤癌中最具侵袭性肿瘤之一,既往诊断为黑色素瘤的个体的风险最高。
在美国,CM在男性最常见诊断中名列第五,在女性中名列第七。CM患者数量在增加,而死亡率并没有显著的下降。紫外线辐射受到个体遗传和种族的影响,其仍是CM最大的危险因素。
为了理解癌症幸存者罹患CM的风险,Case Western ReserveSchool of Medicine, Cleveland, Ohio的医学生Geoffrey B. Yang, B.S.和他的团队调查了来自监察、流行病学和终点事件数据库从1988年至2007年的数据。有70819名第一诊断为CM的患者(确诊时间的平均年龄为54岁)纳入了调查,同时包括6353名诊断为CM的癌症幸存者(诊断为黑色素瘤的平均年龄是70岁)。
研究者们发现既往诊断为黑色素瘤的患者有更高的风险患上黑色素瘤——这一结果和其他调查相一致。在年龄低于45岁的第一诊断为癌症的患者中,有777名最后发展为皮肤黑色素瘤。
在既往有CM、其他皮肤肿瘤、卡波齐肉瘤、淋巴瘤和女性乳腺癌的患者中发生CM的危险性显著增高。年龄在45岁以上最初诊断为癌症的患者如果第一诊断为CM、其他皮肤肿瘤、女性乳腺癌、淋巴瘤、白血病、视网膜黑色素瘤和前列腺癌的发生CM的危险性显著增高。
研究者解释:“两组队列中与更好的预后相关的特点包括性别为女性、诊断为黑色素瘤的年龄小于45岁、已婚、白种人而不是黑种人、Breslow深度降低(肿瘤细胞侵袭的深度)、肿瘤没有溃疡、没有结节、没有远处转移的证据(从肿瘤原发部位扩展到身体的其他部位)”。
研究人员表示:“第一次诊断为CM的患者中皮肤黑色素瘤是最常见的继发肿瘤(15年来危险性保持增加),我们的结果提示在黑色素瘤幸存者中需要持续进行监察”。(生物谷Bioon.com)
doi:10.1001/archdermatol.2011.1133
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Risk and Survival of Cutaneous Melanoma Diagnosed Subsequent to a Previous Cancer
Geoffrey B. Yang, BS; Jill S. Barnholtz-Sloan, PhD; Yanwen Chen, PhD; Jeremy S. Bordeaux, MD, MPH
Objective To understand the risk of cutaneous melanoma (CM) following a previous cancer.
Design Using the Surveillance, Epidemiology, and End Results database (1988-2007), we compared a cohort of patients diagnosed as having CM as a first cancer with a cohort of patients diagnosed as having CM following a previous cancer.
Participants We included 70 819 patients with CM as a first primary cancer and 6353 patients with CM following a previous cancer.
Main Outcome Measures We calculated the relative risk (RR) for development of primary CM following a previous cancer and used Cox modeling to examine survival characteristics of the 2 cohorts.
Results Patients younger than 45 years at first cancer diagnosis had significantly higher risk of CM following cutaneous melanoma (RR, 11.89; 95% CI, 10.83-13.03), other nonepithelial skin cancer (RR, 2.81; 95% CI, 1.13-5.79), Kaposi sarcoma (RR, 3.26; 95% CI 1.41-6.42), female breast cancer (RR, 1.38; (1.11-1.70), and lymphoma (RR, 1.79; (95% CI, 1.30-2.41). Patients 45 years or older at first cancer diagnosis had significantly higher risk of CM following cutaneous melanoma (RR, 8.36; 95% CI, 7.93-8.81), other nonepithelial skin cancer (RR, 2.00; 95% CI 1.35-2.86), ocular melanoma (RR, 5.34; 95% CI 3.42-7.94), female breast cancer (RR, 1.12; 95% CI, 1.03-1.21), prostate cancer (RR, 1.08; 95% CI, 1.03-1.13), thyroid cancer (RR, 1.40; 95% CI, 1.06-1.82), lymphoma (RR, 1.34; 95% CI, 1.16-1.55), and leukemia (RR, 1.79; 95% CI, 1.49-2.13). Characteristics associated with better survival in both cohorts included female sex, age younger than 45 years at melanoma diagnosis, being married, being white vs black, decreasing Breslow depth, lack of tumor ulceration, no nodal involvement, and absence of metastases.
Conclusion Given that cutaneous melanoma is the most common second primary cancer in patients with a first CM (a risk that remains elevated for over 15 years), our results suggest the need for continued skin surveillance in melanoma survivors.