Elsevier

European Journal of Cancer

Volume 50, Issue 3, February 2014, Pages 602-610
European Journal of Cancer

Conditional survival of malignant melanoma in The Netherlands: 1994–2008

https://doi.org/10.1016/j.ejca.2013.10.019Get rights and content

Abstract

Background

Cutaneous malignant melanoma causes the majority of skin cancer related deaths and features increasing incidence and mortality rates in the Netherlands. Conditional survival analysis is performed on patients who survived the preceding year(s).

Methods

Patients with invasive melanoma, as recorded in the population-based Netherlands Cancer Registry, were included. To assess prognosis of melanoma survivors according to gender and Breslow thickness, conditional five-year relative survival was calculated for lymph node negative melanoma patients and conditional one-year relative survival was analysed for melanoma patients with and without nodal involvement.

Findings

Between 1994 and 2008, 40,050 patients developed a melanoma (stage I–III, of whom 6% with nodal involvement). Six to 8 years after diagnosis, survival of patients with a 1–2 mm (T2) thick melanoma equalised the general population. Conditional five-year relative survival for patients with >4 mm thick (T4) melanomas increased from about 60% at diagnosis to 90% at 7 years after diagnosis. Largest improvements were found in patients with thick melanomas and female patients with nodal involvement.

Interpretation

The prognosis for melanoma survivors improved with each additional year of survival after diagnosis, except for patients with a ⩽1 mm thick melanoma, who never had any excess mortality during follow-up. Conditional survival of melanoma was better amongst females, amongst those with lower Breslow thickness and nodal stage.

Introduction

Cutaneous malignant melanoma encompasses a large variety of malignancies with different disease presentations and short-term outcomes. Cutaneous malignant melanoma causes the majority of skin cancer related deaths and is currently the sixth most common cancer in the Netherlands (excluding keratinocyte carcinomas of the skin) with continuously increasing incidence rates of 4% annually [1]. Similar rising trends have been reported in most European countries, while Australia, New Zealand, North America and Israel showed a stabilising or declining trend (mainly youngest age groups) [2]. Norway has decreasing incidence trends in young age groups and increasing trends in older patients [3]. Mortality rates increased in the Netherlands [1] and several other European countries [4], but remained stable or decreased in Scotland, the United Kingdom, Denmark (females), Iceland (males), the United States and Australia [5], [6], [7], [8], [9], [10], [11].

Survival estimates for cancer patients are traditionally reported from the time since cancer diagnosis and do not provide estimates for patients who have already survived a period of time after initial diagnosis and treatment. Patients diagnosed with nodal or distant metastases often die soon after diagnosis and negatively affect standard survival curves which are estimated at time of diagnosis. The right side of melanoma Kaplan–Meier survival curves shows that there is generally a proportion of patients that have a better survival. The increasing incidence and relatively good survival, mostly due to thin melanomas, have resulted in a growing group of melanoma survivors. At the same time, patients with early nodal metastases (i.e. Sentinel Node (SN) positive patients), who have survived for 2–3 years after initial surgery, have a large chance to survive for a longer period of time. Conditional survival analysis is a method to estimate the survival rate of patients who already survived a certain period of time, i.e. patients on the right side of Kaplan–Meier survival curves.

These estimates give important information to cancer patients, i.e. almost a third of cancer survivors in the Netherlands experienced either changes in their work situation, problems with life insurances and/or problems regarding house mortgages due to their cancer [12]. These problems could decrease several years after diagnosis if conditional survival show trends to 100%.

Recent studies reported conditional survival estimates for melanoma in Europe [10], [13], [14], [15], Australia [16] and the United States of America (USA) [17], [18], [19], [20]. In this study, we present conditional 5-year relative survival rates for Dutch melanoma patients without nodal involvement and conditional 1-year relative survival rates for patients with and without nodal involvement, stratified for gender and Breslow thickness. This stratification is useful for caregivers and patients to be informed on their prognosis years after their initial diagnosis.

Section snippets

Data collection

For this study, population-based data was used from the nationwide Netherlands Cancer Registry (NCR), which was started in 1989 and is maintained and hosted by the Comprehensive Cancer Centres [1]. The NCR is primarily based on notification of all newly diagnosed malignancies in the Netherlands by the automated pathology archive (PALGA) [1]. Information on patient characteristics such as gender and date of birth, as well as tumour characteristics such as date of diagnosis, location

Results

A total of 40,050 patients (16,942 men and 23,108 women) were diagnosed with a stage I–III melanoma (N+: 6%, N0: 94%) between 1994 and 2010. The median ages of male and female patients were 56 (interquartile range (IQR): 44–67) and 52 (IQR: 40–65). The median (IQR) follow-up time was 5.4 (IQR: 2.8–9.4) years (males: 4.8[2.5–8.6] years, females: 5.8[3.0–9.8] years). Female patients had more thin melanomas (T1, Breslow thickness ⩽1.0 mm) compared to male patients (54% versus 44%, p < 0.0001). Thick

Discussion

Survival of patients with advanced melanoma was fairly good 5 years after diagnosis. To the best of our knowledge, this is the largest population-based study providing accurate conditional survival estimates for melanoma patients according to gender, Breslow thickness and nodal status with 1- and 5-year CRS estimates up to 15 and 11 years after diagnosis, respectively. Dutch melanoma patients who are N0 at diagnosis and still alive 5 years after diagnosis have a high probability of surviving

Contributions of all authors

R.J.T. van der Leest: Writing, study design, data interpretation, literature search; L.N. van Steenbergen: Data analysis, writing/editing, figures; L.M. Hollestein: Writing/editing manuscript, data interpretation; E. de Vries: Study design, data interpretation, writing/editing manuscript; T. Nijsten: Study design, data interpretation, editing manuscript; A.C.J. van Akkooi: Writing/editing manuscript, data interpretation; M.L.G. Janssen-Heijnen: Study design, data interpretation, writing/editing

Funding

This work was supported by the Dutch Cancer Society [Grant No. IKZ 2009-4316], project ‘Insight into health aspects of long-term cancer survivors in the Netherlands – a tool for caregivers and cancer survivors’).

Conflict of interest statement

None declared.

Acknowledgements

This research was performed within the framework of the project ‘Insight into health aspects of long-term cancer survivors in The Netherlands – a tool for caregivers and cancer survivors’ (Dutch Cancer Society Grant IKZ 2009-4316).The funding source had no involvement in data collection, data analysis and data interpretation.

We thank the registrars of The Netherlands Cancer Registry for their dedicated data collection. We thank Arjen Joosse for his critically reading of the manuscript and

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