Melanoma-specific survival is worse in the elderly: a multicentric cohort study.
Journal
Melanoma research
ISSN: 1473-5636
Titre abrégé: Melanoma Res
Pays: England
ID NLM: 9109623
Informations de publication
Date de publication:
01 12 2023
01 12 2023
Historique:
medline:
30
10
2023
pubmed:
12
9
2023
entrez:
11
9
2023
Statut:
ppublish
Résumé
We aimed to characterise cutaneous melanoma in the elderly and determine its association with poorer prognosis. We studied a prospective cohort of the melanoma population in Catalonia between 2012 and 2016. We compared young patient group (<75 years old) with elderly patient group (≥75 years old). We included 3009 patients (52.5% women) from 14 centres, with a mean age at diagnosis of 61.1 years. In the ≥75-year-old group there was a predominance of men (53.9% vs. 45.5%, P < 0.001), melanoma was more frequently located in the head and neck area (37.7% vs. 15.5%, P < 0.001) and lentigo maligna melanoma subtype was significantly more frequent (31.4% vs. 11.6%, P < 0.001), as were nodular melanoma and acral lentiginous melanoma ( P < 0.001). In older people, Breslow index, the presence of ulceration and mitotic rate were higher than in younger people. Kaplan-Meier survival curves showed longer melanoma-specific survival (MSS) and melanoma-free survival (MFS) in <75-year-old group compared to the elderly group. Cox regression models demonstrated reduced MSS in patients ≥75 years regardless of gender, location, IB, ulceration and lymph node status at diagnosis (HR 1.54, P = 0.013) whereas MFS was not independently associated with elderly when head and neck location was considered. Age appears to be an independent risk factor for MSS but not for MFS. Worse melanoma prognosis in elderly could be explained by factors unrelated to the tumour, such as age-related frailty and comorbidities that limit the access to systemic treatments and, eventually, age-related immune dysfunction.
Identifiants
pubmed: 37696262
doi: 10.1097/CMR.0000000000000923
pii: 00008390-990000000-00099
doi:
Types de publication
Multicenter Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
532-538Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Références
Melanoma of the skin - cancer stat facts. SEER. https://seer.cancer.gov/statfacts/html/melan.html . [Accessed 9 March 2021].
Puig S, Marcoval J, Paradelo C, Azon A, Bartralot R, Bel S, et al. Melanoma incidence increases in the elderly of Catalonia but not in the younger population: effect of prevention or consequence of immigration? Acta Derm Venereol 2015; 95:422–426.
Iglesias-Pena N, Paradela S, Tejera-Vaquerizo A, Boada A, Fonseca E. Cutaneous Melanoma in the elderly: review of a growing problem. Actas Dermosifiliogr 2019; 110:434–447.
Podlipnik S, Carrera C, Boada A, Richarz N, Marcoval J, Ferreres JR, et al.; On Behalf Of The Network Of Melanoma Centres Of Catalonia. Incidence of melanoma in Catalonia, Spain, is rapidly increasing in the elderly population. a multicentric cohort study. J Clin Med 2020; 9:3396.
DeSantis CE, Miller KD, Dale W, Mohile SG, Cohen HJ, Leach CR, et al. Cancer statistics for adults aged 85 years and older, 2019. CA Cancer J Clin 2019; 69:452–467.
Miller AJ, Mihm MC. Melanoma. N Engl J Med 2006; 355:51–65.
Lasithiotakis KG, Petrakis IE, Garbe C. Cutaneous melanoma in the elderly: epidemiology, prognosis and treatment. Melanoma Res 2010; 20:163–170.
Garcovich S, Colloca G, Sollena P, Andrea B, Balducci L, Cho WC, et al. Skin cancer epidemics in the elderly as an emerging issue in geriatric oncology. Aging Dis 2017; 8:643–661.
Sáenz S, Conejo-Mir J, Cayuela A. Melanoma epidemiology in Spain. Actas Dermosifiliogr 2005; 96:411–418.
Testori A, Stanganelli I, Della Grazia L, Mahadavan L. Diagnosis of melanoma in the elderly and surgical implications. Surg Oncol 2004; 13:211–221.
Montero I, Requena C, Traves V, García-Casado Z, Kumar R, Nagore E. Age-related characteristics of cutaneous melanoma in a Spanish Mediterranean population. Int J Dermatol 2015; 54:778–784.
Macdonald JB, Dueck AC, Gray RJ, Wasif N, Swanson DL, Sekulic A, et al. Malignant melanoma in the elderly: different regional disease and poorer prognosis. J Cancer 2011; 2:538–543.
Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Coit DG, Atkins MB, et al. Age as a prognostic factor in patients with localized melanoma and regional metastases. Ann Surg Oncol 2013; 20:3961–3968.
Sasson DC, Smetona JT, Parsaei Y, Papageorge M, Ariyan S, Olino K, et al. Malignant melanoma in older adults: different patient or different disease? Cureus 2023; 15:e34742.
Hegde UP, Chakraborty N, Mukherji B, Grant Kels JM. Metastatic melanoma in the older patient: immunologic insights and treatment outcomes. Expert Rev Pharmacoecon Outcomes Res 2011; 11:185–193.
Orloff M. Melanoma immunotherapy in the elderly. Curr Oncol Rep 2018; 20:20.
Bateni SB, Johns AJ, Gingrich AA, Gholami S, Bold RJ, Canter RJ, et al. Elderly age is associated with more conservative treatment of invasive melanoma. Anticancer Res 2020; 40:2895–2903.
McMasters KM, Noyes RD, Reintgen DS, Goydos JS, Beitsch PD, Davidson BS, et al.; Sunbelt Melanoma Trial. Lessons learned from the Sunbelt Melanoma Trial. J Surg Oncol 2004; 86:212–223.
Perier-Muzet M, Gatt E, Péron J, Falandry C, Amini-Adlé M, Thomas L, et al. Association of immunotherapy with overall survival in elderly patients with melanoma. JAMA Dermatol 2018; 154:82–87.