1. Enhanced survival in patients with multiple primary melanoma
- Author
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Scott W. Menzies and Anna Doubrovsky
- Subjects
Oncology ,Male ,medicine.medical_specialty ,Skin Neoplasms ,Time Factors ,Dermatology ,Cohort Studies ,Neoplasms, Multiple Primary ,Internal medicine ,Epidemiology ,medicine ,Humans ,neoplasms ,Survival rate ,Melanoma ,Survival analysis ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Proportional hazards model ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Survival Analysis ,Confidence interval ,Surgery ,Survival Rate ,Female ,business ,Cohort study - Abstract
Objective To calculate survival probabilities of patients with 3 or more multiple primary melanomas. Design Retrospective cohort study of patients with primary melanoma. Setting Patients treated at a tertiary center (Sydney Melanoma Unit, Sydney, Australia) for stage I or II melanoma between 1983 and 1999. Patients From 5250 patients with primary melanoma, 264 (5.0%) had double and 34 (0.6%) had 3 or more primary melanoma lesions. Results The estimated 10-year risk for developing a second primary melanoma in these patients was 12.7% (95% confidence interval [CI], 10.5%-14.9%). For those patients who had 2 primary melanomas, the estimated 10-year risk of developing a third lesion was 27.7% (95% CI, 14.7%-36.7%). When controlling for known prognostic factors in a proportional hazards regression model, the number of primary melanomas was a significant favorable survival predictor when the thickest or the first tumor was modeled. In patients with 3 or more primary melanomas, 31 survived when 25 (95% CI, 22-27) were expected to survive. Patients who survive longer may have the opportunity to develop multiple primary melanomas. Patients who encountered all their primary lesions within 2 years may not be subject to this bias. Within the 3 or more melanoma set, 11 patients had all primary melanomas within 2 years. All survived, whereas 9 (95% CI, 8-10) were expected to survive. Conclusions Patients with 3 or more primary melanoma lesions survive longer than anticipated. Such enhanced survival in patients with 3 or more primary melanomas may be consistent with observations of an "immunization effect" in animals inoculated with multiple tumors.
- Published
- 2003