Predictors of survival in head and neck mucosal melanoma
Autor: | John R. David, Alain C. Mita, Zachary S. Zumsteg, Kevin Scher, Stephen L. Shiao, Emi J. Yoshida, Matthew Q. Schmidt, Allen S. Ho |
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Rok vydání: | 2017 |
Předmět: |
Oncology
Adult Male Cancer Research medicine.medical_specialty 03 medical and health sciences Young Adult 0302 clinical medicine Internal medicine medicine Humans 030223 otorhinolaryngology Melanoma Survival analysis Aged Aged 80 and over Mucous Membrane Proportional hazards model business.industry Hazard ratio Head and neck cancer Mucosal melanoma Cancer Middle Aged medicine.disease Prognosis Combined Modality Therapy Survival Analysis Paranasal sinuses medicine.anatomical_structure Head and Neck Neoplasms 030220 oncology & carcinogenesis Female Oral Surgery business |
Zdroj: | Oral oncology. 73 |
ISSN: | 1879-0593 |
Popis: | To evaluate hospital-based data of head and neck mucosal melanoma patients in order to identify predictors of survival.The National Cancer Data Base was used to identify 1368 patients with head and neck mucosal melanoma diagnosed between the years of 2004 and 2012. The Kaplan-Meier method was utilized to estimate overall survival, and multivariate Cox regression analyses were performed to assess the impact of covariates on survival after adjusting for confounding variables.Median follow-up was 55.2months. Median survival of all patients was 29.3months, and the 5-year survival was 27.4%. After adjusting for other prognostic factors in multivariate analysis, paranasal sinus location [hazard ratio (HR)=1.54, 95% Confidence Interval (CI)=1.30-1.82, P0.001)] and the use of radiotherapy alone for definitive local treatment (HR=2.27, 95% CI=1.72-2.98, P0.001) were associated with worse survival. Similar results were seen in the subgroup of patients with complete clinical staging information. In terms of patterns of care, the use of combined surgery and radiotherapy as the primary local treatment modality has significant increased from 2004 and 2012 (P=0.03).Outcomes in mucosal melanoma of the head and neck remain suboptimal, despite increased use of multimodality local therapy, likely due to the high risk of distant metastases. Mucosal melanomas arising from the paranasal sinuses have particularly poor prognosis. Novel therapeutic paradigms for head and neck mucosal melanoma, incorporating systemic therapies to decrease the risk of distant relapse, should be pursued in clinical trials. |
Databáze: | OpenAIRE |
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