title: Gender differences in melanoma survival: female patients have a decreased risk of metastasis.
abstract: Female melanoma patients generally exhibit significantly longer survival than male patients. This population-based cohort study aimed to investigate gender differences in survival and disease progression across all stages of cutaneous melanoma. A total of 11,774 melanoma cases extracted from the Munich Cancer Registry (Germany), diagnosed between 1978 and September 2007, were eligible to enter the study. Hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for tumor and patient characteristics, were estimated for the end points of survival, regional and systemic progression, and survival after progression. A significant female advantage was observed for melanoma-specific survival (adjusted HR 0.62; 95% CI 0.56-0.70). Women were at a lower risk of progression (HR 0.68; 95% CI 0.62-0.75), including a lower risk of lymph node metastasis (HR 0.58; 95% CI 0.51-0.65) and visceral metastases (HR 0.56; 95% CI 0.49-0.65). They retained a significant survival advantage after first progression (HR 0.81; 95% CI 0.71-0.92) and lymph node metastasis (HR 0.80; 95% CI 0.66-0.96), but this became borderline significant (HR 0.88; 95% CI 0.76-1.03) after visceral metastasis. Localized melanomas in women had a lower propensity to metastasize, resulting in a better survival when compared with men, even after first disease progression. These results suggest differences in tumor-host interaction across gender.
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. a.joosse@erasmusmc.nl
authors.forename: Arjen
authors.initials: A
authors.lastname: Joosse
authors.forename: Esther
authors.initials: E
authors.lastname: de Vries
authors.forename: Renate
authors.initials: R
authors.lastname: Eckel
authors.forename: Tamar
authors.initials: T
authors.lastname: Nijsten
authors.forename: Alexander M M
authors.initials: AM
authors.lastname: Eggermont
authors.forename: Dieter
authors.initials: D
authors.lastname: Hölzel
authors.forename: Jan Willem W
authors.initials: JW
authors.lastname: Coebergh
authors.forename: Jutta
authors.initials: J
authors.lastname: Engel
mesh_terms: D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005858:Germany; D006801:Humans; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000401:mortality* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate