Advertisement

A population-based registry study on relative survival from melanoma in Germany stratified by tumor thickness for each histologic subtype

Published:September 19, 2018DOI:https://doi.org/10.1016/j.jaad.2018.09.018

      Background

      Differences in relative survival (RS) of melanoma between histologic subtypes were discussed to be mainly caused by tumor thickness.

      Objective

      To investigate RS of melanoma, stratified by tumor thickness for each histologic subtype, and identify survival trends.

      Methods

      With use of cancer registry data on melanoma cases (International Classification of Diseases, 10th Revision, codes C43.0–C43.9) diagnosed in Germany in 1997–2013, 5- and 10-year age-standardized RS stratified by histologic subtype and stratified or standardized by T stage was estimated by standard and modeled period analyses. We restricted 10-year RS analyses to patients younger than 75 years.

      Results

      We analyzed 82,901 cases. Overall, the 5- and 10-year RS rates were 91.7% and 90.8%, respectively. Prognosis worsened with increasing T stage for all histologic subtypes, but T-stage distribution varied substantially. Survival differences by histologic subtype were strongly alleviated after adjustment for T stage but remained significant. Overall, 5-year RS increased significantly (by 3.8 percentage points) between the periods 2002–2005 and 2010–2013. This increase was no longer seen after adjustment for T stage.

      Limitations

      Exclusion of cases on account of missing information on T stages, changes in the definition of T stages, and lack of information on screening and treatment limit our analyses.

      Conclusion

      Differences in RS between histologic subtypes were strongly mediated by tumor thickness. Over time, RS of melanoma increased as a result of changes in T-stage distribution.

      Key words

      Abbreviations used:

      ALM (acral lentiginous melanoma), DCO (death certificate only), LMM (lentigo maligna melanoma), NM (nodular melanoma), RS (relative survival), SE (standard error), SSM (superficial spreading melanoma), TNM (tumor node and metastasis)
      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ferlay J.
        • Soerjomataram I.
        • Ervik M.
        • et al.
        GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [online].
        International Agency for Research on Cancer, Lyon, France2013 (Available at:)
      1. Association of Population-Based Cancer Registries in Germany. GEKID atlas.
        2016 (Available at:)
        http://www.gekid.de/
        Date accessed: July 23, 2018
        • Krebsfrüherkennungs-Richtlinien
        Bundesanzeiger AT 31.12.2014 B4.
        German Federal Gazette, Germany2014 (Available at:)
        • European Medicines Agency
        Summary of Product Characteristics.
        Yervoy Ipilimumab, 2011 (Available at:)
        • European Medicines Agency
        European public assessment report (EPAR) Summary for the Public. Zelboraf vemurafenib. EMA/53181/2012 EMEA/H/C/002409. London, United Kingdom.
        2012 (Available at:)
        • Eisemann N.
        • Jansen L.
        • Holleczek B.
        • et al.
        Up-to-date results on survival of patients with melanoma in Germany.
        Br J Dermatol. 2012; 167: 606-612
        • Barnes B.
        • Kraywinkel K.
        • Nowossadeck E.
        • et al.
        Report on Cancer in Germany, 2016.
        ([in German]) Robert Koch Institute, Berlin2016: 53-56
        • LeBoit P.E.
        • Burg G.
        • Weedon D.
        • et al.
        World Health Organization Classification of Tumours. Pathology and Genetics of Skin Tumours.
        IARC Press, Lyon2006
        • Liu W.
        • Dowling J.P.
        • Murray W.K.
        • et al.
        Rate of growth in melanomas: characteristics and associations of rapidly growing melanomas.
        Arch Dermatol. 2006; 142: 1551-1558
        • Koh H.K.
        • Michalik E.
        • Sober A.J.
        • et al.
        Lentigo maligna melanoma has no better prognosis than other types of melanoma.
        J Clin Oncol. 1984; 2: 994-1001
        • Cox N.H.
        • Aitchison T.C.
        • Sirel J.M.
        • MacKie R.M.
        Comparison between lentigo maligna melanoma and other histogenetic types of malignant melanoma of the head and neck. Scottish Melanoma Group.
        Br J Cancer. 1996; 73: 940-944
        • Breitbart E.W.
        • Waldmann A.
        • Nolte S.
        • et al.
        Systematic skin cancer screening in Northern Germany.
        J Am Acad Dermatol. 2012; 66: 201-211
        • Conic R.Z.
        • Cabrera C.I.
        • Khorana A.A.
        • Gastman B.R.
        Determination of the impact of melanoma surgical timing on survival using the National Cancer Database.
        J Am Acad Dermatol. 2018; 78: 40-46.e7
        • Jansen L.
        • Castro F.A.
        • Gondos A.
        • et al.
        Recent cancer survival in Germany: an analysis of common and less common cancers.
        Int J Cancer. 2015; 136: 2649-2658
        • Union for International Cancer Control (UICC)
        TNM classification of malignant tumours; publications and resources.
        2017 (Available at:)
        • Brenner H.
        • Hakulinen T.
        Implications of incomplete registration of deaths on long-term survival estimates from population-based cancer registries.
        Int J Cancer. 2009; 125: 432-437
        • Henson D.E.
        • Ries L.A.
        The relative survival rate.
        Cancer. 1995; 76: 1687-1688
        • Brenner H.
        • Arndt V.
        Long-term survival rates of patients with prostate cancer in the prostate-specific antigen screening era: population-based estimates for the year 2000 by period analysis.
        J Clin Oncol. 2005; 23: 441-447
        • Ederer F.
        • Heise H.
        Instructions to IBM 650 Programmers in Processing Survival Computations.
        National Cancer Institute, Bethesda, MD1959
        • Brenner H.
        • Hakulinen T.
        Up-to-date and precise estimates of cancer patient survival: model-based period analysis.
        Am J Epidemiol. 2006; 164: 689-696
        • Brenner H.
        • Gefeller O.
        An alternative approach to monitoring cancer patient survival.
        Cancer. 1996; 78: 2004-2010
        • Corazziari I.
        • Quinn M.
        • Capocaccia R.
        Standard cancer patient population for age standardising survival ratios.
        Eur J Cancer. 2004; 40: 2307-2316
        • Brenner H.
        • Gefeller O.
        • Hakulinen T.
        • Arndt V.
        SAS Macro Period and Sas Macro Periodh: Period Analysis of Survival Data.
        2004 (Available at:)
        • Brenner H.
        • Gefeller O.
        • Hakulinen T.
        A computer program for period analysis of cancer patient survival.
        Eur J Cancer. 2002; 38: 690-695
        • Cockburn M.
        • Peng D.
        • Key C.
        SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics.
        in: Ries L.A.G. Young J.L. Keel G.E. Eisner M.P. Lin Y.D. Horner M.-J. National Cancer Institute, SEER Program, Bethesda, MD2007: 93-100
        • Koh H.K.
        • Lew R.A.
        • Prout M.N.
        Screening for melanoma/skin cancer: theoretic and practical considerations.
        J Am Acad Dermatol. 1989; 20: 159-172
        • Humpel N.
        • Magee C.
        • Jones S.C.
        The impact of a cancer diagnosis on the health behaviors of cancer survivors and their family and friends.
        Support Care Cancer. 2007; 15: 621-630
        • Howlader N.
        • Noone A.M.
        • Krapcho M.
        • et al.
        SEER cancer statistics review, 1975-2013.
        National Cancer Institute, Bethesda, MD2016 (Available at:)
        • De Angelis R.
        • Sant M.
        • Coleman M.P.
        • et al.
        Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE-5-a population-based study.
        Lancet Oncol. 2014; 15: 23-34
        • Gondos A.
        • Bray F.
        • Hakulinen T.
        • et al.
        EUNICE Survival Working Group. Trends in cancer survival in 11 European populations from 1990 to 2009: a model-based analysis.
        Ann Oncol. 2009; 20: 564-573
        • Galceran J.
        • Uhry Z.
        • Marcos-Gragera R.
        • et al.
        Trends in net survival from skin malignant melanoma in six European Latin countries: results from the SUDCAN population-based study.
        Eur J Cancer Prev. 2017; 26: S77-S84
        • Shaikh W.R.
        • Dusza S.W.
        • Weinstock M.A.
        • et al.
        Melanoma thickness and survival trends in the United States, 1989 to 2009.
        J Natl Cancer Inst. 2016; : 108
        • Downing A.
        • Yu X.Q.
        • Newton-Bishop J.
        • et al.
        Trends in prognostic factors and survival from cutaneous melanoma in Yorkshire, UK and New South Wales, Australia between 1993 and 2003.
        Int J Cancer. 2008; 123: 861-866
        • Levell N.J.
        • Beattie C.C.
        • Shuster S.
        • Greenberg D.C.
        Melanoma epidemic: a midsummer night's dream?.
        Br J Dermatol. 2009; 161: 630-634
        • Wittekind C.
        • Wagner G.
        TNM Classification of Malignant Tumours.
        ([in German])5th ed. Springer, Berlin, Heidelberg, New York1997
        • Wittekind C.
        • Meyer H.J.
        • Bootz F.
        TNM Classification of Malignant Tumours.
        ([in German])6th ed. Springer, Heidelberg, New York2002