title: Superior outcome of women with stage I/II cutaneous melanoma: pooled analysis of four European Organisation for Research and Treatment of Cancer phase III trials.
abstract: OBJECTIVE
  Several studies observed a female advantage in the prognosis of cutaneous melanoma, for which behavioral factors or an underlying biologic mechanism might be responsible. Using complete and reliable follow-up data from four phase III trials of the European Organisation for Research and Treatment of Cancer (EORTC) Melanoma Group, we explored the female advantage across multiple end points and in relation to other important prognostic indicators.
  
  
  METHODS
  Patients diagnosed with localized melanoma were included in EORTC adjuvant treatment trials 18832, 18871, 18952, and 18961 and randomly assigned during the period of 1984 to 2005. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% CIs for women compared with men, adjusted for age, Breslow thickness, body site, ulceration, performed lymph node dissection, and treatment.
  
  
  RESULTS
  A total of 2,672 patients with stage I/II melanoma were included. Women had a highly consistent and independent advantage in overall survival (adjusted HR, 0.70; 95% CI, 0.59 to 0.83), disease-specific survival (adjusted HR, 0.74; 95% CI, 0.62 to 0.88), time to lymph node metastasis (adjusted HR, 0.70; 95% CI, 0.51 to 0.96), and time to distant metastasis (adjusted HR, 0.69; 95% CI, 0.59 to 0.81). Subgroup analysis showed that the female advantage was consistent across all prognostic subgroups (with the possible exception of head and neck melanomas) and in pre- and postmenopausal age groups.
  
  
  CONCLUSIONS
  Women have a consistent and independent relative advantage in all aspects of the progression of localized melanoma of approximately 30%, most likely caused by an underlying biologic sex difference.
authors.affiliation: Department of Public Health, Erasmus University Medical Center, PO Box 2040 3000 CA, Rotterdam, the Netherlands.
authors.forename: Arjen
authors.initials: A
authors.lastname: Joosse
authors.forename: Sandra
authors.initials: S
authors.lastname: Collette
authors.forename: Stefan
authors.initials: S
authors.lastname: Suciu
authors.forename: Tamar
authors.initials: T
authors.lastname: Nijsten
authors.forename: Ferdy
authors.initials: F
authors.lastname: Lejeune
authors.forename: Ulrich R
authors.initials: UR
authors.lastname: Kleeberg
authors.forename: Jan Willem W
authors.initials: JW
authors.lastname: Coebergh
authors.forename: Alexander M M
authors.initials: AM
authors.lastname: Eggermont
authors.forename: Esther
authors.initials: E
authors.lastname: de Vries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D011379:Prognosis; D012727:Sex Characteristics; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult