Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Acta Oncol. 2020 Jan;59(1):4-12. doi: 10.1080/0284186X.2019.1643914. Epub 2019 Jul 26.
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. All patients diagnosed with cutaneous melanoma between 1989 and 2015 ( = 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 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 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). 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.
老年人中黑色素瘤发病率最高，大多数西方国家的人口都在老龄化。我们评估了过去几十年中年轻患者和老年患者之间发病率和生存率的差距是如何发展的。所有于 1989 年至 2015 年间被诊断患有皮肤黑色素瘤的患者（ = 84,827）均来自荷兰癌症登记处。老年人定义为年龄≥70 岁。描述了患者和肿瘤特征的差异，计算了特定年龄的发病率，并进行了相对生存率（RS）和多变量分析，以估计死亡率的相对过剩率（RER）。在老年男性中，黑色素瘤年龄标准化发病率从 1989 年的 18/100,000 人年（py）增加到 2015 年的 103/100,000 py；在老年女性中，发病率从 1989 年的 23/100,000 py 增加到 70/100,000 py。在年轻男性和女性中，发病率分别从 8/100,000 py 增加到 21/100,000 py 和从 13/100,000 py 增加到 28/100,000 py。在老年男性和女性中，Breslow 厚度中位数从 1989-1997 年的 1.8 毫米下降到 2015 年的 1.1 毫米（2003 年）和从 1.6 毫米下降到 1.1 毫米（2003 年）和从 1.1 毫米下降到 0.9 毫米和 0.9 毫米下降到 0.8 毫米（2003 年）。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%），在老年女性中从 81%（95%CI：78%-85%）增加到 89%（95%CI：87%-91%）。在年轻男性和女性中，RS 从 82%（95%CI：81%-83%）增加到 90%（95%CI：90%-91%）和从 92%（95%CI：92%-93%）增加到 96%（95%CI：95%-96%）。在病例组合校正后，老年男性和女性的生存率不再随时间改善（RER 2010-2015 比 2003-2009：0.97；95%CI：0.81-1.16 和 0.95；95%CI：0.79-1.16）。而在年轻男性和女性中，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）。由于老年人发病率的急剧上升，年轻人和老年人之间黑色素瘤发病率的差距正在扩大。由于 Breslow 厚度差距的缩小，生存率的差异正在缩小。
