Conditional survival estimates improve over time for patients with advanced melanoma: results from a population-based analysis

Abstract

Background: Conditional survival (CS) has emerged as a clinically relevant measure of prognosis for cancer survivors. The objective of this analysis was to provide melanoma-specific CS estimates to help clinicians promote more informed patient decision making.

Methods: Patients with melanoma and at least 5 years of follow-up were identified from the Surveillance Epidemiology and End Results registry (1988-2000). By using the methods of Kaplan and Meier, stage-specific, 5-year CS estimates were independently calculated for survivors for each year after diagnosis. Stage-specific multivariate Cox regression models including baseline survivor functions were used to calculate adjusted melanoma-specific CS for different subgroups of patients further stratified by age, gender, race, marital status, anatomic tumor location, and tumor histology.

Results: Five-year CS estimates for patients with stage I disease remained constant at 97% annually, while for patients with stages II, III, and IV disease, 5-year CS estimates from time 0 (diagnosis) to 5 years improved from 72% to 86%, 51% to 87%, and 19% to 84%, respectively. Multivariate CS analysis revealed that differences in stages II through IV CS based on age, gender, and race decreased over time.

Conclusions: Five-year melanoma-specific CS estimates improve dramatically over time for survivors with advanced stages of disease. These prognostic data are critical to patients for both treatment and nontreatment related life decisions.

Figure 1

Figure 1A: Traditional Kaplan-Meier estimate of Melanoma Disease-Specific Survival at the time of diagnosis stratified by disease stage. Figure 1B: Traditional Kaplan-Meier estimate of Overall Survival at the time of diagnosis stratified by disease stage.

Figure 1

Figure 1A: Traditional Kaplan-Meier estimate of Melanoma Disease-Specific Survival at the time of diagnosis stratified by disease stage. Figure 1B: Traditional Kaplan-Meier estimate of Overall Survival at the time of diagnosis stratified by disease stage.

Figure 2

Figure 2A–B: Melanoma-specific (A) and Overall (B) 5-year Conditional Survival estimates stratified by disease stage. Error bars represent the standard error.

Figure 3

Figure 3A–D. Stages I–IV Melanoma-specific 5-year Adjusted Conditional Survival stratified by age (≥50 v <50). Error bars represent the standard error. (A: stage I; B: stage II; C: stage III; D: stage IV)