第八版美国癌症联合委员会分期的 III 期黑色素瘤患者中枢神经系统转移的累积发生率和预测因素。
Cumulative Incidence and Predictors of CNS Metastasis for Patients With American Joint Committee on Cancer 8th Edition Stage III Melanoma.
机构信息
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.
出版信息
J Clin Oncol. 2020 May 1;38(13):1429-1441. doi: 10.1200/JCO.19.01508. Epub 2020 Jan 28.
PURPOSE
Improved understanding of the incidence, risk factors, and timing of CNS metastasis is needed to inform surveillance strategies for patients with melanoma.
PATIENTS AND METHODS
Clinical data were extracted from the databases of 2 major melanoma centers in the United States and Australia for 1,918 patients with American Joint Committee on Cancer (AJCC) 8th edition stage III melanoma, diagnosed from 1998-2014, who had (negative) baseline CNS imaging within 4 months of diagnosis. The cumulative incidence of CNS metastasis was calculated in the presence of the competing risk of death, from stage III presentation and at benchmark time points 1, 2, and 5 years postdiagnosis.
RESULTS
At a median follow-up of 70.2 months, distant recurrence occurred in 711 patients (37.1%). The first site of distant metastasis was CNS only for 3.9% of patients, CNS and extracranial (EC) for 1.8%, and EC only for 31.4%. Overall, 16.7% of patients were diagnosed with CNS metastasis during follow-up. The cumulative incidence of CNS metastasis was 3.6% (95% CI, 2.9% to 4.6%) at 1 year, 9.6% (95% CI, 8.3% to 11.0%) at 2 years, and 15.8% (95% CI, 14.1% to 17.6%) at 5 years. The risk of CNS metastasis was significantly influenced by patient sex, age, AJCC stage, primary tumor site, and primary tumor mitotic rate in multivariable and conditional analyses. High primary tumor mitotic rate was significantly associated with increased risk of CNS metastasis at diagnosis and all subsequent time points examined.
CONCLUSION
Similar rates of CNS metastasis were observed in 2 large, geographically distinct cohorts of patients with stage III melanoma. The results highlight the importance of primary tumor mitotic rate. Furthermore, they provide a framework for developing evidence-based surveillance strategies and evaluating the impact of contemporary adjuvant therapies on the risk of CNS metastasis development.
目的
为了制定黑色素瘤患者的监测策略，需要深入了解中枢神经系统（CNS）转移的发生率、风险因素和时间。
患者与方法
从美国和澳大利亚的两个主要黑色素瘤中心的数据库中提取了临床数据，纳入了 1998 年至 2014 年间诊断为 AJCC 第 8 版 III 期黑色素瘤且诊断前 4 个月内有（阴性）基线 CNS 影像学检查的 1918 例患者。从 III 期发病时起，以及在诊断后 1、2 和 5 年的基准时间点，使用竞争风险方法计算 CNS 转移的累积发生率。
结果
中位随访 70.2 个月时，711 例患者（37.1%）出现远处复发。首次远处转移部位仅为 CNS 的患者占 3.9%，CNS 和颅外（EC）的患者占 1.8%，EC 仅为 31.4%。总体而言，16.7%的患者在随访期间被诊断为 CNS 转移。1 年、2 年和 5 年的 CNS 转移累积发生率分别为 3.6%（95%CI，2.9%至 4.6%）、9.6%（95%CI，8.3%至 11.0%）和 15.8%（95%CI，14.1%至 17.6%）。多变量和条件分析显示，患者性别、年龄、AJCC 分期、原发肿瘤部位和原发肿瘤有丝分裂率显著影响 CNS 转移风险。高的原发肿瘤有丝分裂率与诊断时和所有后续检查点的 CNS 转移风险增加显著相关。
结论
在两个大型、地理位置不同的 III 期黑色素瘤患者队列中，观察到相似的 CNS 转移率。结果强调了原发肿瘤有丝分裂率的重要性。此外，这些结果为制定基于证据的监测策略和评估当代辅助治疗对 CNS 转移发展风险的影响提供了框架。
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