Melanoma in older patients: declining gap in survival between younger and older patients with melanoma
Melanoma in older patients: declining gap in survival between younger and older patients with melanoma
复制标题
DOI：
10.1080/0284186x.2019.1643914
复制
发表时间：
2019-07-25
期刊：
影响因子：
3.1
通讯作者：
Louwman, Marieke W. J.
中科院分区：
文献类型：
--
作者：
Schuurman, Melinda S.;Hollestein, Loes M.;Louwman, Marieke W. J.
背景：老年人黑色素瘤的发病率最高，而且大多数西方国家的人口正在老龄化。我们评估了过去几十年来年轻患者和老年患者之间的发病率和生存率差距是如何发展的。材料和方法：1989 年至 2015 年间诊断患有皮肤黑色素瘤的所有患者 (n = 84,827) 均来自荷兰癌症登记处。老年人被定义为年龄≥70岁。描述了患者和肿瘤特征的差异，计算了年龄特异性发病率，并进行了相对生存率（RS）和估计死亡相对过量率（RER）的多变量分析结果：在老年男性中，黑色素瘤年龄标准化发病率在1989年至2015年间从18人年增加到103/100,000人年（py），在老年女性中从23人年增加到70/100,000人年（py） py。在年轻男性和女性中，该比率分别从 8 py 增加到 21 py，从 13 py 增加到 28/100,000 py。老年男性和女性的中位 Breslow 厚度从 1.8 毫米下降到 1.1 毫米，从 1.6 毫米下降到 1.1 毫米（2003 年与 2015 年相比），年轻男性和女性的中位 Breslow 厚度从 1.1 毫米下降到 0.9 毫米，从 0.9 毫米下降到 0.8 毫米。在老年男性中，5年RS从1989-1997年的67%（95% CI：63%-72%）增加到2007-2015年的85%（95% CI：83%-87%），在老年女性中，5年RS从81%（95% CI：78%-85%）增加到89%（95% CI：87%-91%）。在年轻男性和女性中，RS 发生率从 82% (95% CI: 81%-83%) 增加到 90% (95% CI: 90%-91%)，从 92% (95% CI: 92%-93%) 增加到 96% (95% CI: 95%-96%)。经过病例组合校正后，随着时间的推移，老年男性和女性的生存率不再表现出改善（RER 2010-2015 年与 2003-2009 年相比：0.97；95% CI：0.81-1.16 和 0.95；95% CI：0.79-1.16）。而年轻男性和女性的生存率仍然有所提高（RER 0.75；95% CI：0.67-0.83 和 0.77；95% CI：0.67-0.89）。结论：由于老年人发病率大幅增加，年轻人和老年人之间黑色素瘤发病率的差距正在扩大。生存率差异正在缩小，这与布雷斯洛厚度差距缩小有关。
Background: Older people have the highest incidence of melanoma and the population in most Western countries is ageing. We evaluated how the gap in incidence and survival between younger and older patients has developed during the past decades. Material and methods: All patients diagnosed with cutaneous melanoma between 1989 and 2015 (n = 84,827) were identified from the Netherlands Cancer Registry. Elderly were defined as aged >= 70 years. Differences in patient and tumor characteristics were described, age-specific incidence rates were calculated, and relative survival (RS) and multivariable analyses estimating the Relative Excess Rate of dying (RER) were conducted Results: In older men, the melanoma age-standardized incidence increased from 18 to 103/100,000 person-years (py) between 1989 and 2015 and in older women from 23 to 70/100,000 py. In younger men and women, it increased from 8 to 21 and from 13 to 28/100,000 py, respectively. Median Breslow thickness declined from 1.8 to 1.1 mm and from 1.6 to 1.1 mm in older men and women (2003 versus 2015), and from 1.1 to 0.9 mm and 0.9 to 0.8 mm in younger men and women. In older men, 5-year RS increased from 67% (95% CI: 63%-72%) in 1989-1997 to 85% (95% CI: 83%-87%) in 2007-2015 and in older women from 81% (95% CI: 78%-85%) to 89% (95% CI: 87%-91%). In younger men and women, RS increased from 82% (95% CI: 81%-83%) to 90% (95% CI: 90%-91%) and from 92% (95% CI: 92%-93%) to 96% (95% CI: 95%-96%). After case-mix correction , older men and women no longer showed an improved survival over time (RER 2010-2015 versus 2003-2009: 0.97; 95% CI: 0.81-1.16 and 0.95; 95% CI: 0.79-1.16). Whereas in younger men and women survival remained improved (RER 0.75; 95% CI: 0.67-0.83 and 0.77; 95%CI: 0.67-0.89). Conclusion: The gap in melanoma incidence between younger and older people is increasing due to a strong increase in incidence in older adults. Disparities in survival are declining, related to a narrowing gap in Breslow thickness.