Background: Risk assessment models are increasingly being used in oncology to improve therapeutic and follow-up decisions for individual patients. Methods: In our study, we used a university hospital registry database containing data on patients diagnosed with invasive cutaneous melanoma between 2000 and 2019 (training cohort: N = 1402; validation cohort: N = 601). Using multivariate Cox regression models, we identified clinicopathological variables that are independent risk factors for melanoma recurrence at specific sites. We then constructed nomograms to predict the probability of recurrence at 3, 5, and 10 years. Results: Age, sex, primary tumor location, histological subtype, Clark invasion level and AJCC pT category were independent prognostic factors for melanoma recurrence in regional lymph nodes. Age, sex, primary tumor location, Clark level of invasion, AJCC pT stage and regional lymph node metastasis were risk factors for skin/soft tissue (including muscle)/non-regional lymph node metastases. We found that AJCC pT category and sex were also independent prognostic factors for melanoma recurrence in the lung, visceral sites, and brain. Furthermore, the nomogram predicting recurrence in the lung and visceral sites incorporated the presence of regional lymph node and skin/soft tissue/non-regional lymph node metastases. ROC curves showed good performance of the nomograms in both the training and validation cohorts. The calibration curve showed a good fit. Conclusion: Our results support the high prognostic value of AJCC pT stage and patient sex, which remained consistent across all melanoma stages, and demonstrate the feasibility of creating nomogram models to predict recurrence risk in melanoma patients.
背景：风险评估模型在肿瘤学领域正日益广泛地应用于优化个体患者的治疗及随访决策。方法：本研究基于某大学医院2000年至2019年确诊为侵袭性皮肤黑色素瘤患者的登记数据库（训练队列：N=1402；验证队列：N=601），采用多变量Cox回归模型识别特定部位黑色素瘤复发的独立临床病理危险因素，并构建预测3年、5年及10年复发概率的列线图模型。结果：年龄、性别、原发肿瘤部位、组织学亚型、Clark浸润层次及AJCC pT分期是区域淋巴结复发的独立预后因素；年龄、性别、原发肿瘤部位、Clark浸润层次、AJCC pT分期及区域淋巴结转移是皮肤/软组织（含肌肉）/非区域淋巴结转移的危险因素。研究发现AJCC pT分期与性别同样是肺、内脏部位及脑部复发的独立预后因素。此外，预测肺与内脏部位复发的列线图还整合了区域淋巴结转移及皮肤/软组织/非区域淋巴结转移状态。受试者工作特征曲线显示列线图在训练队列与验证队列中均表现良好，校准曲线显示模型拟合度优异。结论：本研究结果证实AJCC pT分期与患者性别具有稳定的高预后价值，该结论在所有黑色素瘤分期中保持一致，并验证了构建列线图模型预测黑色素瘤患者复发风险的可行性。
肿瘤(癌症)患者之家