黑色素瘤女性的存活比男性多30%


  【24drs.com】一篇新分析確認,臨床局部分期I/II期的皮膚黑色素瘤女性的整體存活比男性多30%。
  
  荷蘭鹿特丹Erasmus大學醫學中心Arjen Joosse博士表示,黑色素瘤女性患者的存活機會(比男性)多30%,淋巴結或其他器官轉移機會少30%。當我們比較探討性別風險比的其他大型研究結果時,發現這30%的差距,所以,對於不同研究設計、不同分組的各種族女性,這似乎是個明顯優勢。
  
  這篇研究線上登載於4月30日臨床腫瘤期刊。
  
  根據編輯評論,如果觀察到的這30%的性別差異最後可以用於男性的及早偵測和預防策略,可以在美國和全球拯救諸多生命,值得加以突破。
  
  Joosse博士等人在這篇研究中探討皮膚黑色素瘤患者的女性優勢,分析的資料是「European Organisation for Research」和「Treatment of Cancer Melanoma Group」的4篇第3期試驗的完整可信追蹤資料。
  
  這些試驗在1984-2005年進行,包括2,672名第I/II期黑色素瘤患者— 1,274名男性(47.7%)與1,398名女性(52.3%)。
  
  校正年紀、腫瘤侵犯厚度、身體部位、潰瘍、進行淋巴結廓清術、和治療方式之後,女性的整體存活(校正風險比[HR],0.70;95%信心區間[CI],0.59-0.83)、疾病特定存活(HR,0.74;95% CI,0.62-0.88)、發生淋巴結轉移的時間(校正HR,0.70;95% CI,0.51-0.96)與發生遠端轉移的時間(較正HR,0.69;95% CI,0.59-0.81)等項目都佔有優勢。
  
  這些性別上的存活差異結果確認了最近的其他資料。
  
  根據最近的報告(CA Cancer J Clin. 2011;61:212-236),美國去年估計有70,230例侵犯性皮膚黑色素瘤,其中43% (30,220例)是女性,不過,在8,790例黑色素瘤相關死亡中,只有35%(3,040例死亡)是女性。
  
  作者們報告指出,在所有預後分組、以及停經前和停經後年齡分組,都存在有女性優勢(頭頸部黑色素瘤可能例外)。
  
  Joosse博士指出,停經前和停經後年齡婦女,都比同齡男性具有優勢,因而認為女性荷爾蒙(停經後降低)似乎不是引起這個女性優勢的原因。
  
  作者們寫道,揭開黑色素瘤的女性優勢原因,將有助於治療。可能是基礎生物性別差異、腫瘤或宿主相關因素等引起這個女性優勢。
  
  佛羅里達坦帕市H. Lee Moffitt癌症中心的Vernon K. Sondak醫師等人的編輯論述中認為,男性對皮膚癌較少警覺、抗拒篩檢、比較不會尋找相關知識,因而造成了前述的女性優勢。
  
  他們寫道,可能是這些行為特徵的直接後果,男性,特別是年長男性,發生比較厚的腫瘤且因而提高了死亡率風險。
  
  但是Joosse博士並不這麼確定,他指出,次組分析認為行為因素並不能完全解釋女性的優勢。
  
  那麼,男性和女性皮膚黑色素瘤要以不同方式治療嗎?Joosse博士表示,還言之過早。我們必須先知道這30%差異的原因,不過,或許也該讓醫師知道此病的男性病患有較高機會轉移和死於該病。
  
  編輯們表示同意,他們指出,目前,缺乏黑色素瘤之結果差異的荷爾蒙因素或其他特定因素的明確資料,因此還無法做出男性和女性不同治療介入的任何建議;首先或許應提高男性的皮膚癌警覺和檢查實務。
  
  不過,Sondak醫師等人認為,因為觀察到男性的淋巴結轉移機率較大,男性和女性的前哨淋巴結切片適應症是否應該不同。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6818&x_classno=0&x_chkdelpoint=Y
  

Women Have 30% Better Survival Than Men With Melanoma

By Megan Brooks
Medscape Medical News

May 10, 2012 — Women with clinically localized stage I/II cutaneous melanoma have a clear 30% advantage over their male counterparts in terms of overall outcome, a new analysis confirms.

"Women have a 30% better chance of surviving their melanoma and a 30% lower chance of experiencing a metastasis to the lymph nodes and to other organs," first author Arjen Joosse, MD, PhD, from the Erasmus University Medical Center in Rotterdam, the Netherlands, told Medscape Medical News.

"When we compare our results to other large studies reporting gender hazard ratios, we see the 30% magnitude...so it seems a very robust advantage for females across continents, subgroups, and different study designs," he added.

The study was published online April 30 in the Journal of Clinical Oncology.

According to an accompanying editorial, "if even a portion of the observed 30% gender-based differences in outcome can be eliminated by focused early detection and prevention strategies in men, this could save many lives in the United States and around the world each year. That is certainly another glass ceiling worth shattering."

In their study, Dr. Joosse and colleagues explored the female advantage in cutaneous melanoma in a pooled analysis of "complete and reliable" follow-up data from 4 phase 3 trials from the European Organisation for Research and Treatment of Cancer Melanoma Group.

The trials were conducted from 1984 to 2005, and involved 2672 patients with stage I/II melanoma — 1274 men (47.7%) and 1398 women (52.3%).

After adjustment for age, Breslow thickness, body site, ulceration, performed lymph node dissection, and treatment, women enjoyed an advantage in terms of overall survival (adjusted hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.59 to 0.83), disease-specific survival (HR, 0.74; 95% CI, 0.62 to 0.88), time to lymph node metastasis (adjusted HR, 0.70; 95% CI, 0.51 to 0.96), and time to distant metastasis (adjusted HR, 0.69; 95% CI, 0.59 to 0.81).

The finding of a sex-based survival difference confirms other recent data.

According to a recent report (CA Cancer J Clin. 2011;61:212-236), there were an estimated 70,230 cases of invasive cutaneous melanoma in the United States last year, 43% (30,220 cases) of which were in women. However, of the 8790 melanoma-related deaths, only 35% (3040 deaths) occurred in women.

Behavior or Biology?

The female advantage was consistent in all prognostic subgroups (with the possible exception of head and neck melanomas) and in pre- and postmenopausal age groups, the authors report.

The finding that women of pre- and postmenopausal age had an "equal advantage" over men of the same age suggests that "female hormones (which decline after menopause) do not seem to cause this female advantage," Dr. Joosse noted.

"Unraveling" the underlying cause of the female advantage in melanoma could be of therapeutic relevance, he added. "It is likely that fundamental biologic sex differences, either tumor- or host-related, cause this female advantage," the authors write.

In their editorial, Vernon K. Sondak, MD, from the H. Lee Moffitt Cancer Center in Tampa, Florida, and coauthors suggest that less awareness, resistance to screening, and less knowledge-seeking behavior among men when it comes to skin cancer might contribute to the female advantage.

"Possibly as a direct consequence of these behavioral traits, men — especially older men — present with thicker tumors and attendant increased mortality risk," they write.

But Dr. Joosse isn't so sure, telling Medscape Medical News that the subgroup analysis suggests that "behavior cannot fully explain the advantage for women."

Treat Differently?

So should men and women with cutaneous melanoma be treated differently? Dr. Joosse said that "it's too soon to say. We need to know the cause of this 30% difference first. However, it might be useful for the clinician to realize that every male patient has a higher chance to metastasize and die from the disease."

The editorialists agree. For now, "the lack of definitive data implicating hormonal or other specific factors in melanoma outcome disparities make any consideration of different therapeutic interventions for men and women with cutaneous melanoma premature," they write. Increasing skin cancer awareness and examination practices among men "should be a priority," they add.

However, Dr. Sondak and colleagues think that "whether the indications for sentinel lymph node biopsy should be different for men and women, given the observed greater propensity for lymphatic metastases in men," should be explored.

The authors and editorialists have disclosed no relevant financial relationships.

J Clin Oncol. Published online April 30, 2012.

    
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