Mortality burden of melanoma: Metastatic site-specific and temporal trends

Abstract

9076 Background: Metastatic melanoma has high disease-specific mortality burden, as measured by Years of Life Lost (YLL). Has mortality burden shifted over time? Methods: This was a retrospective analysis of a prospective database of 14,029 melanoma cases treated at Duke between 1970–2004. Metastatic analyses focused on cases that developed recurrences after initial diagnosis. YLL was calculated by subtracting the survival since diagnosis from the individual’s life expectancy without cancer at an equivalent time of diagnosis, based on U.S. Life Tables, 2003. Average YLL (AYLL) was calculated by group. Survival was calculated by Kaplan Meier method. Results: Of 14,029 cases, 6,810 (49%) had metastases, and of metastatic cases 4,636 (68%) developed recurrences after initial diagnosis; metastatic cases were mean age 49 (SD 15), 60% male, and 99% white. First metastatic sites were lymph nodes 55%, skin 23%, lung 10%, brain 5%, liver 3%, bone 2%, and other 3%. Lymph nodes as first site of metastasis increased in frequency over time (1970s: 51%, 1980s: 54%, and 1990s: 61%). Among metastatic cases, AYLL increased by decade of diagnosis and differed by site of first metastasis (Table). Conclusions: Although a retrospective analysis of a US referral melanoma population, this large-scale analysis suggests that the mortality burden of metastatic melanoma may be increasing over time. This could be due to several factors, including later diagnosis, higher risk of death with initial recurrence in lymph nodes and brain, and lack of available treatments that extend survival. This analysis highlights the continued unmet need to improve survival outcomes in metastatic melanoma. AYLL for fatal cases of metastatic melanoma by decade of diagnosis and site of first metastasis AYLL (SD) Decade of Diagnosis 1970s 21.8 (14.1) 1980s 23.9 (13.1) 1990s 25.4 (12.4) All cases 1970–2004 23.6 (13.3) Site of first metastasis Nodes 25.2 (13.4) Skin 19.9 (13.2) Lung 23.4 (12.4) Brain 25.1 (13.0) Liver 20.1 (12.5) Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Pfizer Pfizer Pfizer