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%, P_het < .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.

中文翻译：

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多原发性黑色素瘤患者的生存：系统评价和荟萃分析。

背景

有关多原发性黑素瘤（MPM）患者生存的文献产生了可变且相反的发现，受到统计学挑战的限制。

目标

为了严格审查有关MPM患者与单个原发性黑色素瘤相比生存情况的可用文献，以及使用的详细统计方法。

方法

在1956年1月至2019年6月期间，对PubMed，Embase，Web of Science和Scopus进行了电子检索，并对其参考进行了交叉核对。包括以英语发表的检查多发性黑色素瘤患者生存率的研究。案例研究和小案例系列被排除在外。

结果

有14项符合纳入条件的研究。根据所使用的统计方法，关于生存的结论差异很大。定量评价包括四项通过划分生存时间来解释生存偏倚的研究，其中三项报告了MPM的生存不利因素，而第四项研究显示生存无差异。合并风险比为1.39（95％置信区间为1.07-1.81），但异质性显着（I ²  = 96.8％，P _het  <.001）。

局限性

研究表明方法学上存在明显的异质性。

结论

当使用可靠的统计方法分析数据时，与单一原发性黑色素瘤患者相比，MPM患者生存不利。