Improvement of overall survival of patients with cutaneous melanoma in Germany, 1976–2001

Abstract

BACKGROUND.A hypothesis generated a retrospective analysis of the improvement of survival over time in patients with cutaneous melanoma (CM) in order to identify factors contributing to this progress.METHODS.A cohort of 4791 patients diagnosed with primary CM in southern Germany between 1976 and 2001 was analyzed. Kaplan‐Meier analyses were performed to estimate and to compare overall survival (OS) and survival after first recurrence (SAR). The Cox proportional hazards model was used to evaluate the effect of multiple variables on OS and SAR.RESULTS.Diagnosis of primary CM during 1990–2001 compared with 1976–1989 was associated with more favorable 10‐year OS (88.6% vs 80.0%, P < .0001). The median tumor thickness at primary diagnosis was significantly lower during the second period (0.75 mm vs 1.07 mm, P < .0001). In the multivariate analysis, adjusted for tumor thickness, ulceration, age, gender, and anatomical site, the period of diagnosis retained its significance as a predictor of OS (P = .002). The SAR was more favorable during the second period in patients who developed their first metastasis in the regional lymph nodes (45.2% vs 32.9%, P = .017) or in distant sites (13.4% vs 2.0%, P = .0002) and this finding persisted in the multivariate analysis.CONCLUSIONS.Improvement of survival of CM patients diagnosed 1990–2001 as compared with 1976–1989 may not be entirely attributable to factors associated with early diagnosis and more favorable primary tumors. Therefore, factors of melanoma management, which changed between the 2 time periods, such as sentinel node biopsy, adjuvant treatment, structured follow‐up, and surgical interventions in distant metastasis, may have to be taken into account. Cancer 2007 © 2007 American Cancer Society.

The forthcoming inexorable decline of cutaneous melanoma mortality in light-skinned populations

“…This hypothesis is supported by studies that examined the influence of year at diagnosis on risk of melanoma death over a fixed duration of follow-up (e.g., 5-year survival) and that took into consideration major predictors of melanoma patient survival. [16,44,45] In these studies, the more recent the year of diagnosis, the better the survival. One study has suggested that vaccination against common infectious diseases in early life was associated with greater melanoma survival [46].…”

Age and gender are significant independent predictors of survival in primary cutaneous melanoma

“…[1][2][3][4] Older persons present more frequently with advanced tumors, lentigo malignant melanomas (LMM), and melanomas arising in sun-exposed anatomic areas and the disease-specific survival (DSS) of melanoma patients over 60 years old is significantly shorter compared with younger ages. 10 Thus, age seems to be a significant prognostic factor for melanoma and its prognostic significance has been demonstrated likewise after adjusting for all known prognostic variables such as tumor thickness, ulceration, etc. 11 This may suggest that the role of age in the natural course of melanoma might not be entirely explained by differences in the proportions of the known clinicopathologic variables of this disease.…”

State of the science 60th anniversary review

“…76 Similarly, Germany reported an improvement in overall survival of patients for the period 1990 to 2001 as compared with 1976 to 1989 that could not be entirely attributed to early diagnosis and more favorable primary tumors. 77 Although in an earlier analysis the median tumor thickness had decreased from 1.81 mm in 1976 to 0.53 mm in 2000, 78 when a multivariate analysis was performed, the more recent time period was an independent factor portending an improved prognosis. 77 One can only postulate as to the possible factors other than early detection that would contribute to this changing epidemiology.…”

“…77 Although in an earlier analysis the median tumor thickness had decreased from 1.81 mm in 1976 to 0.53 mm in 2000, 78 when a multivariate analysis was performed, the more recent time period was an independent factor portending an improved prognosis. 77 One can only postulate as to the possible factors other than early detection that would contribute to this changing epidemiology. Have changing patterns of sun exposure altered the biology of melanoma, or the distribution of hitherto unappreciated biologic subtypes, impacting overall survival?…”