Table_6_Characteristics, Prognosis, and Competing Risk Nomograms of Cutaneous Malignant Melanoma: Evidence for Pigmentary Disorders.docx

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.

目的：皮肤恶性黑色素瘤（CMM）通常表现为一种复杂的疾病过程，预后不良。本研究旨在探讨孤立或多发性癌症对CMM患者预后的影响，以更好地理解CMM的疾病图谱。方法：我们回顾了2004年至2015年来自美国癌症监测、流行病学和最终结果计划（Surveillance, Epidemiology, and End Results Program）的CMM患者的记录。使用累积发病率函数来表示死亡概率。利用一种新颖的因果推断方法来探讨不同类型CMM之间死亡风险差异，并基于竞争风险模型构建了列线图。结果：分析队列包含165,043名以CMM作为首发的原发性恶性肿瘤患者。反复发作的CMM和多发原发性肿瘤患者的总生存状况相似（p = 0.064），但他们的人口统计学和特定原因死亡率的特点与孤立性CMM患者不同（p < 0.001），其平均生存时间分别为75.4个月、77.3个月和66.2个月。进一步应用因果推断以揭示孤立肿瘤和多发肿瘤在亚组中的风险差异，该差异与总体人群（p < 0.05）显著不同，并确定了高死亡风险脆弱群体。建立的竞争风险列线图在预测不同类型CMM的CMM或其他癌症的死亡概率方面具有一致性指数>0.6。结论：不同类型的CMM患者具有不同的预后特征和不同特定原因死亡的风险。本研究结果对于识别特定原因死亡的高风险具有重要意义，可在人群和个体层面早期进行针对性干预。