Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
J Eur Acad Dermatol Venereol. 2019 Nov;33(11):2062-2067. doi: 10.1111/jdv.15760. Epub 2019 Jul 16.
In Europe, one of the highest melanoma incidences is found in the Netherlands. Like in several other European countries, females are more prone to develop melanoma as compared to males, although survival is worse for men.
To identify clinicopathological gender-related differences that may lead to gender-specific preventive measures.
Data from the Dutch Nationwide Network and Registry of Histopathology and Cytopathology (PALGA) were retrieved from patients with primary, cutaneous melanoma in the Netherlands between 2000 and 2014. Patients initially presenting as stage I, II and III without clinically detectable nodal disease were included. Follow-up data were retrieved from the Netherlands Cancer Registry. Gender-related differences were assessed, and to compare relative survival between males and females, multivariable relative excess risks (RER) were calculated.
A total of 54.645 patients were included (43.7% men). In 2000, 41.7% of the cohort was male, as compared to 47.3% in 2014 (P < 0.001). Likewise, in 2000, 51.5% of the deceased cohort was male compared to 60.1% in 2014 (P < 0.001). Men had significantly thicker melanomas at the time of diagnosis [median Breslow thickness 1.00 mm (interquartile range (IQR): 0.60-2.00) vs. 0.82 mm (IQR: 0.50-1.50) for females] and were significantly older at the time of diagnosis, more often had ulcerated melanomas and melanomas localized on the trunk or head and neck. Over time, survival for females improved while that of men decreased (P < 0.001). RER for dying was 1.37 (95% CI: 1.31-1.45) for men in multivariable analysis.
There are evident clinicopathological differences between male and female melanoma patients. After multivariable correction for all these differences, relative survival remains worse for men. Clinicians as well as persons at risk for melanoma should be aware of these differences, as awareness and prevention might lead to a lower incidence and mortality of melanoma. This indicates the need of prevention campaigns integrating and targeting specific risk profiles.
在欧洲，荷兰的黑色素瘤发病率最高。与其他几个欧洲国家一样，女性比男性更容易患上黑色素瘤，尽管男性的存活率较低。
确定可能导致性别特异性预防措施的临床病理性别相关差异。
从 2000 年至 2014 年期间，从荷兰全国组织病理学和细胞学登记处（PALGA）检索了荷兰原发性皮肤黑色素瘤患者的数据。纳入最初表现为 I 期、II 期和 III 期且无临床可检测淋巴结疾病的患者。从荷兰癌症登记处检索随访数据。评估性别相关差异，并计算多变量相对超额风险（RER）以比较男性和女性的相对生存率。
共纳入 54645 例患者（43.7%为男性）。2000 年，队列中 41.7%为男性，而 2014 年为 47.3%（P<0.001）。同样，2000 年，死亡队列中 51.5%为男性，而 2014 年为 60.1%（P<0.001）。男性在诊断时的黑色素瘤明显更厚[中位 Breslow 厚度为 1.00mm（四分位距（IQR）：0.60-2.00）比女性的 0.82mm（IQR：0.50-1.50）]，诊断时年龄明显更大，更常发生溃疡黑色素瘤和位于躯干或头颈部的黑色素瘤。随着时间的推移，女性的生存率提高，而男性的生存率下降（P<0.001）。多变量分析中，男性死于黑色素瘤的 RER 为 1.37（95%CI：1.31-1.45）。
男性和女性黑色素瘤患者存在明显的临床病理差异。在对所有这些差异进行多变量校正后，男性的相对生存率仍然较差。临床医生和黑色素瘤高危人群应意识到这些差异，因为提高认识和预防可能会降低黑色素瘤的发病率和死亡率。这表明需要开展预防运动，整合并针对特定的风险概况。
