Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands.
Ann Oncol. 2012 Feb;23(2):524-30. doi: 10.1093/annonc/mdr128. Epub 2011 May 4.
It has been debated that the epidemic of melanoma is largely due to overdiagnosis, since increases in incidence were mainly among thin melanomas and mortality rates remained stable. Our objective was to examine this controversy in The Netherlands.
Information on newly diagnosed melanoma patients was obtained from The Netherlands Cancer Registry. European Standardized Rates and estimated annual percentage change were calculated for the period 1989-2008. Cohort-based, period-based and multivariate survival analyses were carried out.
The incidence rate of melanoma increased with 4.1% (95% confidence interval 3.6-4.5) annually. Incidence rates of both thin melanomas (≤ 1 mm) and thick melanomas (> 4 mm) increased since 1989. Mortality rates increased mainly in older patients (> 65 years). Ten-year relative survival of males improved significantly from 70% in 1989-1993 to 77% in 2004-2008 (P < 0.001) and for females the 10-year relative survival increased from 85% to 88% (P < 0.01). Recently diagnosed patients had a better prognosis even after adjusting for all known prognostic factors.
Since incidence of melanomas among all Breslow thickness categories increased as well as the mortality rates, the melanoma epidemic in The Netherlands seems to be real and not only due to overdiagnosis.
有人争论说，黑色素瘤的流行在很大程度上是由于过度诊断所致，因为发病率的增加主要集中在薄型黑色素瘤，而死亡率保持稳定。我们的目的是在荷兰检验这一争议。
从荷兰癌症登记处获得新诊断的黑色素瘤患者的信息。计算了 1989-2008 年期间的欧洲标准化发病率和估计的年百分率变化。进行了基于队列、基于时期和多变量生存分析。
黑色素瘤的发病率以每年 4.1%（95%置信区间 3.6-4.5）的速度增长。自 1989 年以来，薄型黑色素瘤（≤1mm）和厚型黑色素瘤（>4mm）的发病率均有所上升。死亡率的增加主要发生在老年患者（>65 岁）。男性的 10 年相对生存率从 1989-1993 年的 70%显著提高到 2004-2008 年的 77%（P<0.001），女性的 10 年相对生存率从 85%提高到 88%（P<0.01）。即使在调整了所有已知的预后因素后，最近诊断的患者的预后仍然更好。
由于所有 Breslow 厚度类别的黑色素瘤发病率和死亡率都有所增加，荷兰的黑色素瘤流行似乎是真实存在的，而不仅仅是由于过度诊断。
