論文No1882
Sleep-Disordered Breathing Is Independently Associated With Increased Aggressiveness of Cutaneous Melanoma: A Multicenter Observational Study in 443 Patients
Miguel Angel Martinez-Garcia, Francisco Campos-Rodriguez, Eduardo Nagore, Antonio Martorell, Jose Luis Rodriguez-Peralto, Erica Riveiro-Falkenbach, Luis Hernandez, Jose Bañuls, Eva Arias, Pablo Ortiz, Valentin Cabriada, Jose Gardeazabal, Josep Maria Montserrat, Cristina Carrera, Jaime Corral, Juan Fernando Masa, Javier Gomez de Terreros, Jorge Abad, Adam Boada, Olga Mediano, Esther de Eusebio, Eusebi Chiner, Pedro Landete, Mercedes Mayos, Ana Fortuño, Ferrán Barbé, Manuel Sánchez de la Torre, Alicia Sanchez de la Torre, Irene Cano, Cristina Gonzalez, Amalia Pérez-Gil, Teresa Gómez-García, Daniela Cullen, Maria Somoza, Manuel Formigón, Felipe Aizpuru, Cristina Navarro, Maria Jose Selma-Ferrer, Alberto Garcia-Ortega, Blanca de Unamuno, Isaac Almendros, Ramón Farré, David Gozal on behalf of the Spanish Sleep Network
CHEST, Volume 154, Issue 6, p1348–1358, 2018.
＜背景＞
睡眠障害性呼吸(SDB)はがんの頻度、死亡率増加と関連しているが、議論のあるところである。
ある特異的ながん患者でこの関連を調べる大規模な研究は今のところない。
この研究ではSDBの重症度と皮膚メラノーマの攻撃性マーカーとの潜在的関連を評価した。
＜方法＞
メラノーマの診断のついた443名が診断後６か月以内に睡眠検査を行った。
一般データを収集し、メラノーマの特徴、無呼吸低呼吸指数(AHI)や
持続性、間欠的夜間オキシヘモグロビン飽和度低下(DI4%)などのポリソムノグラフのパラメータも収集した。
SDBとメラノーマのさまざまな攻撃性マーカー
(Breslow指数、潰瘍の有無、再燃の有無、細胞分裂指数、ステージ、センチネルリンパ節へのダメージ、メラノーマの進展度)
との関連を検討した。
＜結果＞
AHI, DI4%の上位１／３の患者は、下位１／３と比較して
攻撃性メラノーマ(Breslow指数 >1mm)の可能性がそれぞれ1.94倍 (95% CI, 1.14-3.32; P = .022)、
1.93 倍(95% CI, 1.14-3.26; P = .013)高かった（年齢、性別、腫瘍部位、BMIで補正）。
この関連は特にBreslow指数 >2mmで56歳未満の患者で顕著だった。
他の攻撃性マーカーの存在もAHI, DI4%高値と関連していた。
＜感想＞
SDBの重症度は皮膚メラノーマの攻撃性と独立して関連していたようです。
Background
Sleep-disordered breathing (SDB) has been associated with a greater incidence and mortality of cancer, although such findings are inconsistent. However, no large studies are currently available to investigate this association in patients with a specific type of cancer. This study seeks to assess potential relationships between SDB severity and aggressiveness markers of cutaneous melanoma.
Methods
Four hundred and forty-three patients with a diagnosis of melanoma underwent a sleep study within 6 months of diagnosis. General demographics were collected, along with melanoma characteristics and polygraphic parameters consisting of the apnea-hypopnea index (AHI) and indices of both continuous and intermittent night-time oxyhemoglobin desaturation (DI4%). An exploration of independent relationships between SDB and various objective melanoma aggressiveness markers (Breslow index, presence of ulceration, presence of regression, mitotic index, stage of severity, damage to the sentinel lymph, and spreading of the melanoma) was performed.
Results
Patients in the upper tertiles of AHI or DI4% were 1.94 (95% CI, 1.14-3.32; P = .022) and 1.93 (95% CI, 1.14-3.26; P = .013) times more likely, respectively, to present with aggressive melanoma (Breslow index > 1 mm) than those in the lowest tertiles of these sleep attributes after adjustment for age, sex, tumor location, and BMI. This association was particularly prominent among patients < 56 years of age with Breslow index > 2 mm. The presence of the additional markers of aggressiveness was also associated with higher AHI and DI4% values.
Conclusions
The severity of SDB was independently associated with greater aggressiveness of cutaneous melanoma, particularly among younger patients.