METHODS: A review of all cutaneous melanoma cases in the US Surveillance, Epidemiology, and End Results registry from 2004 to 2020 was performed. Breslow thickness was categorized as thin (≤1.0 mm), intermediate (>1-4 mm), or thick (>4 mm). All-cause deaths and melanoma-specific deaths were compared across tumor thickness and stage groups at diagnosis. Survival analysis was performed with nonmelanoma deaths considered as a competing risk to estimate the cumulative incidence of melanoma-specific death.
RESULTS: Most melanoma deaths occurred in patients who initially presented with local disease (53%) compared to regional (36%) or distant (11%) disease (P < 0.001). However, most (66%) of the melanoma-specific deaths in patients who presented with localized disease were in those with intermediate or thick (i.e., Breslow thickness >1.0 mm) primary tumors compared to those with thin melanomas (34%). The cumulative incidence of melanoma-specific death at 10 y in patients with localized thin melanomas at the time of diagnosis was 2.6% (95% confidence intervals 2.5%-2.7%).
CONCLUSIONS: The public health burden in terms of melanoma-specific mortality is related to patients with tumors >1 mm Breslow thickness, many of whom have regional and distant metastatic disease at the time of diagnosis, not patients with thin melanomas.
方法:对美国监测中所有皮肤黑色素瘤病例的回顾,流行病学,并进行了2004年至2020年的最终结果登记。Breslow厚度被归类为薄(≤1.0毫米),中间(>1-4毫米),或厚(>4毫米)。在诊断时,比较了肿瘤厚度和阶段组的全因死亡和黑色素瘤特异性死亡。对被认为是竞争风险的非黑色素瘤死亡进行生存分析,以估计黑色素瘤特异性死亡的累积发生率。
结果:大多数黑色素瘤死亡发生在最初出现局部疾病(53%)的患者中,与局部疾病(36%)或远处疾病(11%)相比(P<0.001)。然而,出现局部疾病的患者中,大多数(66%)的黑色素瘤特异性死亡是中度或重度(即,Breslow厚度>1.0mm)原发性肿瘤与薄黑色素瘤(34%)相比。诊断时,局部薄型黑色素瘤患者在10年时黑色素瘤特异性死亡的累积发生率为2.6%(95%置信区间为2.5%-2.7%)。
结论:就黑色素瘤特异性死亡率而言,公共卫生负担与肿瘤厚度>1mmBreslow患者有关,其中许多人在诊断时患有区域性和远处转移性疾病,不是薄薄的黑色素瘤患者。