Li Si, Tang Tian, Han Jianglong, Liu Wenmin, Chen Ruyan, Deng Haiyu, Jian Tingting, Fu Zhenming
Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China.
Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China.
Cancer Epidemiol. 2024 Feb;88:102515. doi: 10.1016/j.canep.2023.102515. Epub 2024 Jan 4.
Cutaneous malignant melanoma (CMM) causes most skin cancer deaths in the United States (US). The mortality has been decreasing in the US population. We hypothesize that this population-level reduction is mainly attributable to the treatment advances, rather than the successful primary and secondary prevention.
Using data from the Surveillance, Epidemiology, and End Results (SEER) databases, we collected the incidence, incidence-based mortality (IBM), and 5-year survival (5-YS) rates of CMM from 1994 to 2019. Trends by stage and sex were examined by joinpoint regression analyses and age-period-cohort analyses.
The overall incidence of CMM rose by 1.6% yearly from 1994 to 2006 (95% confidence interval [CI]: 0.9% to 2.2%) and then increased with a numerical trend. And we projected the incidence will continue to increase until 2029. In contrast, the IBM for all CMM has decreased yearly by 2.8% (95% CI: -3.9% to -1.8%) since 2010 after continuously increasing by 3.8% annually (95% CI: 3.2% to 4.4%) from 1996 to 2010. For early-stage (localized and regional) CMM, we found the incidence since 2005 plateaued without further increase, while the incidence for CMM at distant stage continuously increased by 1.4% per year (95% CI: 0.9% to 2.0%). Improvements in 5-YS were observed over the study period for all CMM and were most obvious in distant stage. And significant period effects were noted around the year 2010.
This study demonstrated improved survival and reduced mortality of CMM at the US population level since 2010, which were consistent with the introduction of novel therapies. Encouraging effects of primary prevention among adolescents in the most recent cohorts were found. However, the plateaued overall incidence and early diagnosis rates indicated that advances in primary and secondary prevention are very much needed to further control the burden of CMM.
皮肤恶性黑色素瘤（CMM）导致美国大多数皮肤癌死亡。美国人群中的死亡率一直在下降。我们假设这种人群水平的下降主要归因于治疗进展，而非成功的一级和二级预防。
利用监测、流行病学和最终结果（SEER）数据库的数据，我们收集了1994年至2019年CMM的发病率、基于发病率的死亡率（IBM）和5年生存率（5-YS）。通过连接点回归分析和年龄-时期-队列分析研究了按阶段和性别的趋势。
1994年至2006年，CMM的总体发病率每年上升1.6%（95%置信区间[CI]：0.9%至2.2%），然后呈数字趋势上升。我们预计发病率将持续上升至2029年。相比之下，自2010年以来，所有CMM的IBM在1996年至2010年每年持续上升3.8%（95%CI：3.2%至4.4%）之后，每年下降2.8%（95%CI：-3.9%至-1.8%）。对于早期（局限性和区域性）CMM，我们发现自2005年以来发病率趋于平稳，没有进一步上升，而远处期CMM的发病率每年持续上升1.4%（95%CI：0.9%至2.0%）。在研究期间，所有CMM的5-YS均有改善，在远处期最为明显。在2010年左右发现了显著的时期效应。
本研究表明，自2010年以来，美国人群水平上CMM的生存率提高，死亡率降低，这与新疗法的引入一致。在最近的队列中发现了对青少年一级预防的鼓励作用。然而，总体发病率和早期诊断率趋于平稳表明，非常需要一级和二级预防方面的进展来进一步控制CMM的负担。
