Tumour stage distribution and survival of malignant melanoma in Germany 2002-2011

Olaf Schoffer, Stefanie Schülein, Gerlinde Arand, Hans Arnholdt, Dieter Baaske, Ralf C Bargou, Nikolaus Becker, Matthias W Beckmann, Yves Bodack, Beatrix Böhme, Tayfun Bozkurt, Regine Breitsprecher, Andre Buchali, Elke Burger, Ulrike Burger, Klaus Dommisch, Gudrun Elsner, Karin Fernschild, Ulrike Flintzer, Uwe Funke, Michael Gerken, Hubert Göbel, Norbert Grobe, Vera Gumpp, Lucie Heinzerling, Lana Raffaela Kempfer, Alexander Kiani, Monika Klinkhammer-Schalke, Sabine Klöcking, Ute Kreibich, Katrin Knabner, Peter Kuhn, Stine Lutze, Uwe Mäder, Tanja Maisel, Jan Maschke, Martin Middeke, Andreas Neubauer, Antje Niedostatek, Anabelle Opazo-Saez, Christoph Peters, Beatrice Schell, Gerhard Schenkirsch, Harald Schmalenberg, Peter Schmidt, Constanze Schneider, Birgit Schubotz, Anika Seide, Paul Strecker, Sabine Taubenheim, Matthias Wackes, Steffen Weiß, Claudia Welke, Carmen Werner, Christian Wittekind, Jörg Wulff, Heike Zettl, Stefanie J Klug, Olaf Schoffer, Stefanie Schülein, Gerlinde Arand, Hans Arnholdt, Dieter Baaske, Ralf C Bargou, Nikolaus Becker, Matthias W Beckmann, Yves Bodack, Beatrix Böhme, Tayfun Bozkurt, Regine Breitsprecher, Andre Buchali, Elke Burger, Ulrike Burger, Klaus Dommisch, Gudrun Elsner, Karin Fernschild, Ulrike Flintzer, Uwe Funke, Michael Gerken, Hubert Göbel, Norbert Grobe, Vera Gumpp, Lucie Heinzerling, Lana Raffaela Kempfer, Alexander Kiani, Monika Klinkhammer-Schalke, Sabine Klöcking, Ute Kreibich, Katrin Knabner, Peter Kuhn, Stine Lutze, Uwe Mäder, Tanja Maisel, Jan Maschke, Martin Middeke, Andreas Neubauer, Antje Niedostatek, Anabelle Opazo-Saez, Christoph Peters, Beatrice Schell, Gerhard Schenkirsch, Harald Schmalenberg, Peter Schmidt, Constanze Schneider, Birgit Schubotz, Anika Seide, Paul Strecker, Sabine Taubenheim, Matthias Wackes, Steffen Weiß, Claudia Welke, Carmen Werner, Christian Wittekind, Jörg Wulff, Heike Zettl, Stefanie J Klug

Abstract

Background: Over the past two decades, there has been a rising trend in malignant melanoma incidence worldwide. In 2008, Germany introduced a nationwide skin cancer screening program starting at age 35. The aims of this study were to analyse the distribution of malignant melanoma tumour stages over time, as well as demographic and regional differences in stage distribution and survival of melanoma patients.

Methods: Pooled data from 61 895 malignant melanoma patients diagnosed between 2002 and 2011 and documented in 28 German population-based and hospital-based clinical cancer registries were analysed using descriptive methods, joinpoint regression, logistic regression and relative survival.

Results: The number of annually documented cases increased by 53.2% between 2002 (N = 4 779) and 2011 (N = 7 320). There was a statistically significant continuous positive trend in the proportion of stage UICC I cases diagnosed between 2002 and 2011, compared to a negative trend for stage UICC II. No trends were found for stages UICC III and IV respectively. Age (OR 0.97, 95% CI 0.97-0.97), sex (OR 1.18, 95% CI 1.11-1.25), date of diagnosis (OR 1.05, 95% CI 1.04-1.06), 'diagnosis during screening' (OR 3.24, 95% CI 2.50-4.19) and place of residence (OR 1.23, 95% CI 1.16-1.30) had a statistically significant influence on the tumour stage at diagnosis. The overall 5-year relative survival for invasive cases was 83.4% (95% CI 82.8-83.9%).

Conclusions: No distinct changes in the distribution of malignant melanoma tumour stages among those aged 35 and older were seen that could be directly attributed to the introduction of skin cancer screening in 2008.

Keywords: Malignant melanoma; Skin cancer screening; Stage distribution; Survival analysis; TNM staging.

Figures

Fig. 1
Fig. 1
Regional distribution of malignant melanoma cases by place of residence between 2002 and 2011 in Germany, N = 61 895
Fig. 2
Fig. 2
Distribution of UICC stages between 2002 and 2011. a Number of cases, stages UICC 0-IV and X, N = 61 895. b Proportions of malignant melanoma patients, stages UICC I-IV, N = 37 947
Fig. 3
Fig. 3
Proportion of malignant melanoma cases with stages UICC I to IV (stages UICC 0 and X excluded), by year of diagnosis and age (a 15–34 years, b 35–64 years, c 65 years and older), N = 37 947
Fig. 4
Fig. 4
Relative 5-year survival of invasive malignant melanoma patients (UICC 0 excluded) diagnosed between 2002 and 2011, stratified by age (a), sex (b), UICC stage (c) and ‘diagnosis during screening’ (d), N = 49 351

References

    1. Boyle P, Levin B. World Cancer Report 2008. Lyon: International Agency for Research on Cancer; 2008. URL: .
    1. GLOBOCAN 2012, Population Fact Sheets. 2014. Access Date: 21 May 2014. URL: .
    1. Cancer in Germany 2009/2010. 9th ed. Berlin: Robert Koch Institute and the Association of Population-based cancer registries in Germany (GEKID); 2013.
    1. Geller AC, Zhang Z, Sober AJ, Halpern AC, Weinstock MA, Daniels S, et al. The first 15 years of the American Academy of Dermatology skin cancer screening programs: 1985–1999. J Am Acad Dermatol. 2003;48:34–41. doi: 10.1067/mjd.2003.9.
    1. Robert Koch-Institut (RKI). Gesundheitsberichterstattung des Bundes [Federal Health Reporting]. Issue 22: Skin Cancer. Berlin: RKI; 2004.
    1. Eisemann N, Waldmann A, Nolte S, Katalinic A. Population-based Benefits of Skin Cancer Screening. Melanoma Lett. 2012;30:1–5.
    1. Robert Koch-Institut (RKI). Zahlen und Trends aus der Gesundheitsberichterstattung [Figures and Trends from Federal Health Reporting]. GBE kompakt. Berlin: RKI; 2012.
    1. Kassenärztliche Bundesvereinigung (National Association of Statutory Health Insurance Physicians). Press Release 2010 - Erste Bilanz zum Hautkrebsscreening liegt vor [Initial Assessment of Skin Cancer Screening]. KVS-Mitteilungen Heft 7-8. Dresden: Kassenärztliche Vereinigung Sachsen; 2010.
    1. Breitbart EW, Waldmann A, Nolte S, Capellaro M, Greinert R, Volkmer B, et al. Systematic skin cancer screening in Northern Germany. J Am Acad Dermatol. 2012;66:201–211. doi: 10.1016/j.jaad.2010.11.016.
    1. International Union Against Cancer (UICC) Wittekind C, Sobin LH. TNM Classification of Malignant Tumours. 6. Hoboken: Wiley; 2002.
    1. GEKID. 2014. Access Date: 26-9-2014. URL: .
    1. Fritz A, Percy C, Shanmugaratnam K, Sobin L, Parkin DM, Whelan S. International Classification of Diseases for Oncology. 3rd Edition. Geneva: World Health Organization; 2000.
    1. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19:335–351. doi: 10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>;2-Z.
    1. Agresti A. Analysis of ordinal categorical data. New York: Wiley; 1984.
    1. Efron B. Bootstrap Methods: Another Look at the Jackknife. Ann Stat. 1979;7:1–26. doi: 10.1214/aos/1176344552.
    1. Little RJA, Rubin DB. Statistical Analysis with Missing Data. 2. Hoboken: Wiley; 2002.
    1. van Buuren S. Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res. 2007;16:219–242. doi: 10.1177/0962280206074463.
    1. Aalen OO. Nonparametric inference for a family of counting processes. Ann Stat. 1978;6:701–726. doi: 10.1214/aos/1176344247.
    1. Ederer F, Heise H. Instructions to IBM 650 programmers in processing survival computations - methodological note No. 10 - end results section. Bethesda: National Cancer Institute; 1959.
    1. Schoffer O, Niedostatek A, Klug SJ. Estimation of Relative Survival Based on Cancer Registry Data. Rev Bioinforma Biom. 2013;2:77–82.
    1. Kalbfleisch JD, Prentice RL. Statistical analysis of failure time data. 2. New Jersey: Wiley; 2002.
    1. Borgan O, Liestol K. A Note on Confidence Interval and Bands for the Survival data: theory, empirical evaluation, computational realization and applications. Scand J Stat. 1990;18:35–41.
    1. Kalbfleisch JD, Prentice RL. Statistical analysis of failure time data. New York: Wiley; 1980.
    1. Carpenter JR, Kenward MG. Multiple Imputation and its Application. Chichester: Wiley; 2013.
    1. Erdmann F, Lortet-Tieulent J, Schuz J, Zeeb H, Greinert R, Breitbart EW, et al. International trends in the incidence of malignant melanoma 1953–2008--are recent generations at higher or lower risk? Int J Cancer. 2013;132:385–400. doi: 10.1002/ijc.27616.
    1. Criscione VD, Weinstock MA. Melanoma thickness trends in the United States, 1988–2006. J Invest Dermatol. 2010;130:793–797. doi: 10.1038/jid.2009.328.
    1. Baade P, Meng X, Youlden D, Aitken J, Youl P. Time trends and latitudinal differences in melanoma thickness distribution in Australia, 1990–2006. Int J Cancer. 2012;130:170–178. doi: 10.1002/ijc.25996.
    1. Nieto A, Ruiz-Ramos M, Abdel-Kader L, Conde M, Camacho F. Gender differences in rising trends in cutaneous malignant melanoma in Spain, 1975–98. Br J Dermatol. 2003;148:110–116. doi: 10.1046/j.1365-2133.2003.04990.x.
    1. de Vries E, Coebergh JW. Cutaneous malignant melanoma in Europe. Eur J Cancer. 2004;40:2355–2366. doi: 10.1016/j.ejca.2004.06.003.
    1. Howlader N, Noone AM, Krapcho M, Garshell J, Neyman N, Altekruse SF, et al. SEER Cancer Statistics Review 1975–2010. Bethesda: National Cancer Institute; 2013.
    1. Dryden R, Williams B, McCowan C, Themessl-Huber M. What do we know about who does and does not attend general health checks? Findings from a narrative scoping review. BMC Public Health. 2012;12:723. doi: 10.1186/1471-2458-12-723.
    1. Gondos A, Arndt V, Holleczek B, Stegmaier C, Ziegler H, Brenner H. Cancer survival in Germany and the United States at the beginning of the 21st century: an up-to-date comparison by period analysis. Int J Cancer. 2007;121:395–400. doi: 10.1002/ijc.22683.
    1. Hiripi E, Gondos A, Emrich K, Holleczek B, Katalinic A, Luttmann S, et al. Survival from common and rare cancers in Germany in the early 21st century. Ann Oncol. 2012;23:472–479. doi: 10.1093/annonc/mdr131.
    1. Balch CM, Buzaid AC, Soong SJ, Atkins MB, Cascinelli N, Coit DG, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol. 2001;19:3635–3648.
    1. Downing A, Yu XQ, Newton-Bishop J, Forman D. 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. doi: 10.1002/ijc.23495.
    1. Tryggvadottir L, Gislum M, Hakulinen T, Klint A, Engholm G, Storm HH, et al. Trends in the survival of patients diagnosed with malignant melanoma of the skin in the Nordic countries 1964–2003 followed up to the end of 2006. Acta Oncol. 2010;49:665–672. doi: 10.3109/02841861003702528.
    1. de Vries E, Houterman S, Janssen-Heijnen ML, Nijsten T, van de Schans SA, Eggermont AM, et al. Up-to-date survival estimates and historical trends of cutaneous malignant melanoma in the south-east of The Netherlands. Ann Oncol. 2007;18:1110–1116. doi: 10.1093/annonc/mdm087.
    1. De Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D, 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. doi: 10.1016/S1470-2045(13)70546-1.
    1. Joosse A, de Vries E, Eckel R, Nijsten T, Eggermont AM, Holzel D, et al. Gender differences in melanoma survival: female patients have a decreased risk of metastasis. J Invest Dermatol. 2011;131:719–726. doi: 10.1038/jid.2010.354.
    1. Lasithiotakis K, Leiter U, Meier F, Eigentler T, Metzler G, Moehrle M, et al. Age and gender are significant independent predictors of survival in primary cutaneous melanoma. Cancer. 2008;112:1795–1804. doi: 10.1002/cncr.23359.
    1. Scoggins CR, Ross MI, Reintgen DS, Noyes RD, Goydos JS, Beitsch PD, et al. Gender-related differences in outcome for melanoma patients. Ann Surg. 2006;243:693–698. doi: 10.1097/01.sla.0000216771.81362.6b.
    1. de Vries E, Nijsten TE, Visser O, Bastiaannet E, van Hattem S, Janssen-Heijnen ML, et al. Superior survival of females among 10,538 Dutch melanoma patients is independent of Breslow thickness, histologic type and tumor site. Ann Oncol. 2008;19:583–589. doi: 10.1093/annonc/mdm498.
    1. Jansen L, Gondos A, Eberle A, Emrich K, Holleczek B, Katalinic A, et al. Cancer survival in Eastern and Western Germany after the fall of the iron curtain. Eur J Epidemiol. 2012;27:689–693. doi: 10.1007/s10654-012-9723-5.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する