Sex differences in survival from melanoma of the skin: The role of age, anatomic location and stage at diagnosis: A CONCORD-3 study in 59 countries

Abstract

Background: CONCORD-3 highlighted wide disparities in population-based 5-year net survival for cutaneous melanoma during 2000-2014. Studies showed a survival advantage in women, but the reasons are not completely understood. We aim to estimate trends in age-standardised 5-year net survival by sex and to examine the role of age, anatomic location and stage on the survival advantage for women worldwide.

Methods: Patients were grouped into five anatomic locations (head and neck, trunk, limbs, genital organs and not otherwise specified locations), into five age groups (15-29, 30-44, 45-59, 60-74 and 75-99 years) and into binary stage (non-metastatic vs. metastatic). We estimated net survival with the non-parametric Pohar Perme estimator, correcting for background mortality by single-year of age, sex, race/ethnicity where possible and calendar year in each country. All-ages estimates were standardised with the International Cancer Survival Standard weights.

Results: Men were generally older and with higher proportion of metastatic melanomas than women. Overall, the trunk was the most common location in men (range 31 %-58 %) and the lower limbs and hips in women (26 %-40 %). Age-standardised 5-year net survival was lower in men (43 %-92 %) than in women (54 %-95 %) in all countries during 2010-2014 and it was lower at older ages for both sexes. A survival advantage for women was observed for all anatomic sites and for localised disease.

Conclusions: Women had a more favourable distribution of main prognostic factors, and showed highest survival for any prognostic factor. Public health efforts should focus on raising awareness of early signs of melanoma, especially among elderly in South-East Europe and to increase awareness in East-Asia, where survival was poorest.

Keywords: Age; Anatomic site; Disparities; Melanoma; Sex; Stage; Survival.