期刊
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
卷 217, 期 1, 页码 27-34出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jamcollsurg.2013.03.007
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资金
- National Cancer Institute [P01 CA29605, P01 CA12582]
- Melanoma Research Alliance (Washington, DC)
- Dr Miriam & Sheldon G Adelson Medical Research Foundation (Boston, MA)
- Lincy Foundation (Beverly Hills, CA)
- Amyx Foundation, Inc. (Boise, ID)
- Alan and Brenda Borstein (Los Angeles, CA)
- Mr and Mrs Louis Johnson (Stanfield, AZ)
- Heather and Jim Murren (Las Vegas, NV)
- Wayne and Gladys Valley Foundation (Oakland, CA)
- Lance Armstrong Foundation (Austin, TX)
- Samueli Foundation (Corona del Mar, CA)
- John Wayne Cancer Foundation (Newport Beach, CA)
- Wrather Family Foundation (Los Alamos, CA)
BACKGROUND: For patients with melanoma, if there has been no recurrence of disease 10 years after initial treatment, additional disease is believed to be very unlikely. However, such late recurrences are known to occur. The frequency of this phenomenon and its clinical significance are not well characterized due to the difficulty in obtaining relevant data. We examined a large, mature, institutional database to evaluate late recurrence. STUDY DESIGN: The late recurrence cohort was defined as having a disease-free interval of 10 or more years after potentially curative treatment and was compared with an early recurrence cohort recurring within 3 years. Actuarial late recurrence frequency and factors associated with late recurrence were examined. Post-recurrence overall and melanoma-specific survival and prognostic variables were analyzed. RESULTS: Among all patients, 408 exhibited late recurrence (mean disease-free interval 15.7 years). For patients who received primary treatment at our institution with 10 or more years follow-up, 327 of 4,731 (6.9%) showed late recurrence. On an actuarial basis, late recurrence rates were 6.8% and 11.3% at 15 and 20 years, respectively, for those with no recurrence at 10 years. Late recurrence was associated with both tumor (thin, non-ulcerated, non-head/neck, node negative) and patient (younger age, less male predominant) characteristics. Multivariate analysis confirmed younger age, thinner and node negative tumors in the late recurrence group. Late recurrences were more likely to be distant, but were associated with better post-recurrence survival on univariate and multivariate analyses. CONCLUSIONS: Late melanoma recurrence is not rare. It occurs more frequently in certain clinical groups and is associated with improved post-recurrence survival. (C) 2013 by the American College of Surgeons)
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