title: Sex differences in survival of cutaneous melanoma are age dependent: an analysis of 7338 patients.
abstract: This study identified sex differences in clinical presentation and survival for primary cutaneous melanoma without clinical evidence of metastasis at diagnosis from 1976 to 2008 in southern Germany. Melanoma-specific survival curves and estimated survival probabilities were generated using the Kaplan-Meier method. Multivariate survival analyses were carried out using the Cox modeling. Male patients had significantly thicker and more frequently ulcerated tumors and a lower 10-year disease-specific survival (DSS) and recurrence-free survival probability compared with females among patients of 43 years old or younger (DSS: 86.1 vs. 93.2%, P<0.001) and 44-60 years old (DSS: 83.5 vs. 90.1%, P<0.001). The survival advantage of female patients in terms of 10-year DSS and 10-year recurrence-free survival was not observed after an age of 60 years (P=0.21 and 0.51, respectively). Sex was of prognostic importance for DSS and survival after recurrence [hazards ratio (HR): 1.3; 95% confidence interval (CI): 1.1-1.6; P=0.002 and HR: 1.2; 95% CI: 1.0-1.5; P=0.018, respectively]. Stratified by age groups, sex remained of prognostic importance for DSS only in patients of 43 years or younger, and 44-60 years old (HR: 1.5; 95% CI: 1.0-2.1; P=0.03 and HR: 1.4; 95% CI: 1.1-2.0; P=0.02, respectively). Sex is an independent prognostic factor in surviving melanoma. The sex difference in survival with a better outcome for women is confined to melanoma patients of 60 years and younger. In addition, in younger age groups, male patients present with prognostically unfavorable features of primary melanoma. A female survival advantage is also known for other solid tumors such as colon and lung cancer; however, age dependency has not been studied.
authors.affiliation: Department of Dermatology, Center of Dermatooncology, University of Tübingen, Germany. liljana.mervic@kclj.si
authors.forename: Liljana
authors.initials: L
authors.lastname: Mervic
authors.forename: Ulrike
authors.initials: U
authors.lastname: Leiter
authors.forename: Friedegund
authors.initials: F
authors.lastname: Meier
authors.forename: Thomas
authors.initials: T
authors.lastname: Eigentler
authors.forename: Andrea
authors.initials: A
authors.lastname: Forschner
authors.forename: Gisela
authors.initials: G
authors.lastname: Metzler
authors.forename: Igor
authors.initials: I
authors.lastname: Bartenjev
authors.forename: Petra
authors.initials: P
authors.lastname: Büttner
authors.forename: Claus
authors.initials: C
authors.lastname: Garbe
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology; D008875:Middle Aged; D012737:Sex Factors; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology; D016019:Survival Analysis