Table_11_Characteristics, Prognosis, and Competing Risk Nomograms of Cutaneous Malignant Melanoma: Evidence for Pigmentary Disorders.xlsx

PurposeCutaneous malignant melanoma (CMM) always presents as a complex disease process with poor prognosis. The objective of the present study was to explore the influence of solitary or multiple cancers on the prognosis of patients with CMM to better understand the landscape of CMM.
MethodsWe reviewed the records of CMM patients between 2004 and 2015 from the Surveillance, Epidemiology, and End Results Program. The cumulative incidence function was used to represent the probabilities of death. A novel causal inference method was leveraged to explore the risk difference to death between different types of CMM, and nomograms were built based on competing risk models.
ResultsThe analysis cohort contained 165,043 patients with CMM as the first primary malignancy. Patients with recurrent CMM and multiple primary tumors had similar overall survival status (p = 0.064), while their demographics and cause-specific death demonstrated different characteristics than those of patients with solitary CMM (p < 0.001), whose mean survival times are 75.4 and 77.3 months and 66.2 months, respectively. Causal inference was further applied to unveil the risk difference of solitary and multiple tumors in subgroups, which was significantly different from the total population (p < 0.05), and vulnerable groups with high risk of death were identified. The established competing risk nomograms had a concordance index >0.6 on predicting the probabilities of death of CMM or other cancers individually across types of CMM.
ConclusionPatients with different types of CMM had different prognostic characteristics and different risk of cause-specific death. The results of this study are of great significance in identifying the high risk of cause-specific death, enabling targeted intervention in the early period at both the population and individual levels.

研究目的：皮肤恶性黑色素瘤（Cutaneous Malignant Melanoma, CMM）是一类病程复杂且预后不良的疾病。本研究旨在探讨单发或多发癌对CMM患者预后的影响，以更全面地阐明CMM的疾病特征与预后图谱。研究方法：本研究回顾性分析了2004至2015年来自监测、流行病学与最终结果（Surveillance, Epidemiology, and End Results, SEER）计划数据库的CMM患者病历资料。采用累积发病率函数表征死亡概率；运用新型因果推断（causal inference）方法探究不同亚型CMM患者的死亡风险差异，并基于竞争风险模型构建列线图。研究结果：本研究的分析队列共纳入165043例以CMM为首发原发恶性肿瘤的患者。复发性CMM患者与多发原发肿瘤患者的总生存状态无显著差异（p=0.064）；但与单发CMM患者相比，这两类患者的人口学特征及特异性死因死亡特征均存在显著差异（p<0.001），三者的平均生存时间分别为75.4个月、77.3个月及66.2个月。进一步通过因果推断方法揭示了亚组中单发与多发肿瘤患者的死亡风险差异，该差异与总人群的结果存在显著不同（p<0.05），并识别出死亡高风险的脆弱人群。针对不同亚型CMM分别预测CMM相关死亡及其他原因死亡概率时，所构建的竞争风险列线图的一致性指数（concordance index）均大于0.6。研究结论：不同亚型的CMM患者具有不同的预后特征及特异性死因死亡风险。本研究结果对于识别特异性死因死亡高风险人群具有重要意义，可助力在人群及个体层面开展早期靶向干预。