Improving Quality Indicator of Melanoma Management - Change of Melanoma Mortality-to-Incidence Rate Ratio Based on a Hungarian Nationwide Retrospective Study.

Máté Várnai,Péter Holló,Zsófia Barcza,Rolland Gyulai,Csaba Polgár,Zoltán Vokó,Balázs Nagy,Gabriella Liszkay,Kata Knollmajer,György Rokszin,Angéla Benedek,Judit Oláh,Zoltán Polányi,Ibolya Fábián,Zsófia Nagy-Erdei,Zoltán Kiss,Gabriella Emri,András Csejtei,István Kenessey,Andrea R Daniel

doi:10.3389/fonc.2021.745550

Abstract

IntroductionThe incidence of melanoma has been increasing in the last decades. A retrospective Hungarian epidemiological study provided real-world data on incidence and mortality rates. There have been changing trends in incidence in Hungary in the last decade and mortality decreased, shifting mortality-to-incidence rate ratios (MIR). MIR is an indicator of cancer management quality.ObjectivesOur aim is to show the changes of melanoma MIR in Hungary between 2011 and 2018 and to compare the real-world evidence-based results of our Hungarian nationwide retrospective study with other European countries.MethodsMIR is calculated from the age-specific standardized incidence and mortality rates from our study. Annual MIR values are presented for the total population and for both sexes between 2011 and 2018, along with 95% confidence intervals. Comparison with European countries are shown for 2012 and 2018 based on the GLOBOCAN database and Eurostat health care expenditure per capita data.ResultsMIR decreased by 0.035 during the study years. The decrease was same in both sexes (0.031). Male had higher MIRs in all study years. In both 2012 and 2018, Hungarian MIR in both sexes was lower than the European Union average (males: 0.192 vs. 0.212 and 0.148 vs. 0.174 respectively, women: 0.107 vs. 0.129 and 0.083 vs. 0.107 respectively).DiscussionHungarian mortality-to-incidence ratio is the lowest in Central and Eastern Europe and is close to the level of Western and Northern European countries. The results are driven by the high number of new diagnosed melanoma cases.

Highlights

The incidence of melanoma has been increasing in the last decades
Forsea et al calculated Mortalityto-incidence ratios (MIR) for melanoma across Europe based on 2008 GLOBOCAN data and found the highest ratios in Central and Eastern Europe (0.35 on average) and the lowest ratios in Western Europe (0.13 on average)
Our study showed that using realworld population data can result in a somewhat different measure than using an estimate (Figure 3), as the incidence and mortality rates in the RAMM study were lower than the GLOBOCAN estimates

Summary

Introduction

The incidence of melanoma has been increasing in the last decades. A retrospective Hungarian epidemiological study provided real-world data on incidence and mortality rates. There have been changing trends in incidence in Hungary in the last decade and mortality decreased, shifting mortality-to-incidence rate ratios (MIR). The mortality of melanoma showed increasing trends, to incidence [6, 7], there are regions where mortality is decreasing [8,9,10], including Europe (ASR per 100,000 in 2012: 3.1 for males, 1.9 for females, in 2018: 2.8 for males, 1.7 for females) [4, 5]. Our recent epidemiological study presented a change in Hungarian melanoma incidence trend in the last decade and confirmed a decrease in mortality, as well [11]. While incidence and mortality are good measures and useful tools for comparability, the rates themselves may not show the quality of care, as mortality can increase in parallel with rising incidence, despite that the ratio is not changing [12]. The use of MIR for survival estimation is mathematically questionable as the calculation does not use the same population for incidence and mortality [13]

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Conclusion