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Survival in patients with multiple primary melanomas: Systematic review and meta-analysis - 10/10/20

Doi : 10.1016/j.jaad.2020.03.076 
Genevieve Peek, MBBS a, Catherine M. Olsen, PhD b, c, Peter Baade, PhD d, e, f, Danny R. Youlden, PhD d, e, Joanne F. Aitken, PhD d, e, g, h, Adele C. Green, MBBS, PhD b, i, Kiarash Khosrotehrani, MD, PhD a, j, k,
a Queensland Skin and Cancer Foundation, Queensland Institute of Dermatology, South-Brisbane, Queensland, Australia 
b QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia 
c Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia 
d Cancer Council Queensland, Brisbane, Queensland, Australia 
e Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia 
f School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia 
g School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia 
h School of Public Health, The University of Queensland, Brisbane, Queensland, Australia 
i Cancer Research UK, Manchester Institute and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom 
j The Diamantina Institute, Translational Research Institute, The University of Queensland, Brisbane, Queensland, Australia 
k The Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia 

Correspondence to: Kiarash Khosrotehrani, MD, PhD, The University of Queensland Diamantina Institute, Translational Research Institute, 37 Kent St, Woolloongabba, QLD 4102, Australia.The University of Queensland Diamantina InstituteTranslational Research Institute37 Kent StWoolloongabbaQLD4102Australia

Abstract

Background

The literature surrounding survival of patients with multiple primary melanomas (MPM) yields variable and opposing findings, constrained by statistical challenges.

Objectives

To critically examine the available literature regarding survival of patients with MPM compared with a single primary melanoma and detail statistical methods used.

Methods

Electronic searches were performed of PubMed, Embase, Web of Science, and Scopus, with cross-checking of references, for the period January 1956 to June 2019. Studies published in English examining survival in patients with multiple melanomas were included. Case studies and small case series were excluded.

Results

There were 14 studies eligible for inclusion. Conclusions on survival varied markedly depending on the statistical method used. Four studies that accounted for survival bias by partitioning the survival time were included in the quantitative review, with 3 of these reporting a survival disadvantage for MPM, whereas the fourth showed no difference in survival. The pooled hazard ratio was 1.39 (95% confidence interval, 1.07-1.81) but with significant heterogeneity (I2 = 96.8%, Phet < .001).

Limitations

Studies showed significant heterogeneity in methodology.

Conclusion

When data were analyzed with robust statistical methods, patients with MPM had a survival disadvantage compared with patients with a single primary melanoma.

Le texte complet de cet article est disponible en PDF.

Key words : bias, melanoma, mortality, multiple, survival, survival analysis

Abbreviations used : CI, HR, MM, MPM, SPM


Plan


 Funding sources: Dr Khosrotehrani was supported by a National Health and Medical Research Council Fellowship (1125290), and Dr Green was supported by a National Health and Medical Research Council Program Grant (#552429).
 Conflicts of interest: None disclosed.
 IRB approval status: Not applicable.
 Reprints not available from the authors.


© 2020  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 83 - N° 5

P. 1406-1414 - novembre 2020 Retour au numéro
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