ePoster Manager

Currently 3.60/5
1
1
2
2
3
3
4
4
5
5

Rating: 3.6/5 (5 votes cast)

	Authors	Institution
	Mohammed Alkhalifah Sami A. Aldaham J. Acuna	Al-Imam Muhammad bin Saud Islamic University (IMSIU) Florida International University, Miami, Florida, USA

Theme

Clinical Sciences 2

Association between different races and overall survival of melanoma patients in adult U.S. population over 3 decades

Background

Melanoma is a treatable and preventable skin cancer. It is responsible for 75% of deaths among all skin cancers. Melanoma rates are higher recently than 20 years ago. In 2015, there will be an estimated 9940 deaths in the U.S. However, there are no studies that cover 30 years and take race into account for the U.S. population.

Summary of Work

This study is a secondary analysis of a non-concurrent retrospective cohort study of adults in the U.S. who were diagnosed with primary cutaneous melanoma from 1982-2011. Data were from the National Cancer Institute's Surveillance, Epidemiology, and End Result (SEER) Program. The final sample size was 185219. The outcome was overall survival. The main exposure was race/ethnicity. The chi-square test was used to study the association between categorical variables. Kaplan-Meier survival analysis was used to estimate overall survival. Cox proportional hazards regression was to estimate unadjusted and adjusted hazard ratios (HR). Collinearity was assessed as well. A p-value less than 0.05 and 95% confidence interval (CI) was used.

Summary of Results

In the 1982-2011 period most of the patients among all U.S. races were diagnosed at localized stage. Overall, more men were diagnosed than women. Highest mortality rate among group ages were between 30-39. More cases were diagnosed in the most recent decade. The association between vital status and other variables was statistically significant. In 2002-2011, only 5.2% of individuals with melanoma died. Before controlling for other risk factors, non-Hispanic Black patients had an HR of 4.3 (95% CI 4.0-4.5). In the adjusted model, their HR was 0.7 (95% CI 0.6-0.8) in comparison with the reference group of non-Hispanic white patients. Logically and analytically, the more advanced the stage at diagnosis, the worse survival the patient had in general (P-value was <0.001 for age categories). Median follow-up was 81 months and no collinearity was observed in the adjusted model.

more detail

Conclusion

In conclusion, survival was affected by race. The non-Hispanic Black patients had the lowest HR of 0.7 (95% CI 0.5-0.7) in comparison to the reference group of non-Hispanic White patients. The less severe the stage at diagnosis, the better the survival. The aging process increases HR.

References

Jason A. Zell PC, Mehrdad Mobasher, Argyrios Ziogas, Frank L. Meyskens Jr, and Hoda Anton-Culver. Survival for Patients With Invasive Cutaneous Melanoma Among Ethnic Groups: The Effects of Socioeconomic Status and Treatment. Journal Of Clinical Oncology. 2008;26(1):66-75.

MacKie RM, Bray CA, Hole DJ, et al. Incidence of and survival from malignant melanoma in Scotland: an epidemiological study. Lancet. Aug 24 2002;360(9333):587-591.

Fisher EBHaDE. Melanoma Epidemiology, Risk Factors, and Clinical Phenotypes. InTech; 2011.

Wu XC, Eide MJ, King J, et al. Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006. Journal of the American Academy of Dermatology. Nov 2011;65(5 Suppl 1):S26-37.

Gamba CS, Clarke CA, Keegan TH, Tao L, Swetter SM. Melanoma survival disadvantage in young, non-Hispanic white males compared with females. JAMA dermatology. Aug 2013;149(8):912-920.

Chang AE, Karnell LH, Menck HR. The National Cancer Data Base report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer. Oct 15 1998;83(8):1664-1678.

Edgar P. Simard P, MPH; Elizabeth M. Ward, PhD; Rebecca Siegel, MPH; Ahmedin Jemal, DVM, PhD. Cancers With Increasing Incidence Trends in theUnited States: 1999 Through 2008. Cancer Journal for Clinicians. 2012;62:118-128.

Jiang AJ, Rambhatla PV, Eide MJ. Socioeconomic and lifestyle factors and melanoma: a systematic review. The British journal of dermatology. Apr 2015;172(4):885-915.

Menon IA, Persad S, Ranadive NS, Haberman HF. Effects of ultraviolet-visible irradiation in the presence of melanin isolated from human black or red hair upon Ehrlich ascites carcinoma cells. Cancer research. Jul 1983;43(7):3165-3169.

Brenner M, Hearing VJ. The protective role of melanin against UV damage in human skin. Photochemistry and photobiology. May-Jun 2008;84(3):539-549.

Shasa Hu MYP, PhD; Glenn Allen, MPH; Dorothy F. Parker, MHS; Fangchao Ma, MD, PhD; Panta Rouhani, PhD, MPH; Robert S. Kirsner, MD, PhD. Disparity in Melanoma. A Trend Analysis of Melanoma Incidence and Stage at Diagnosis Among Whites, Hispanics, and Blacks in Florida. American Medical Association. 2009:1369-1374.

Designed & Managed by Innovative Technology®

Summary of Results

Table1: Demographic characteristics of US adults patients of Primary Cutaneous Melanoma in the period of 1982-2011 (N=185219).
	Race\Ethnicity
Characteristics	White Non-Hisp 169844 (%)	black non-Hisp 3070 (%)	Hispanic 4616 (%)	Others 2303 (%)	Sig. p-Value
Stage					<0.001
In Situ	33.4	12.1	27.9	23.7
Localized	56.9	53.1	56.2	52.5
Regional	7.3	27.6	12.1	18.5
Distant	2.3	7.1	3.8	5.3
Gender					<0.001
Male	56.8	71.9	55.1	56.6
Female	43.2	28.1	44.9	43.4
Age at Diagnosis					<0.001
<30 years old	5.7	14.7	10.2	8.6
30-39	13.1	33.3	25.8	17.4
40-49	17.9	22.8	20.6	18.5
50-59	19.7	10.4	14.1	17.2
60-69	18.9	8.2	12.7	13.2
≥ 70 years old	24.7	10.7	16.7	25.1
Decades of Diagnosis					<0.001
1982-1991	20.9	27.4	24.9	19.8
1992-2001	32.8	39.9	33.5	37.1
2002-2011	46.3	32.7	41.6	34.1

Table 2: Unadjusted association between vital status and risk factors in U.S. adults patients of Primary Cutaneous Melanoma, 1982-2011 (N=185219)
		Vital Status
	Characteristics	Alive or dead of other cause	Dead of melanoma	p-value
		161785 (%)	23434 (%)
	Race
	White Non-Hisp	87.9	12.1
	black non-Hisp	59.9	40.1	<0.001
	Hispanic	76.5	23.5	<0.001
	Others	79.9	20.1	<0.001
	Stage at Diagnosis
	In Situ	98.8	1.2
	Localized	92.9	7.1	<0.001
	Regional	67.9	32.1	<0.001
	Distant	24.0	76.0	<0.001
	Gender
	Male	82.9	17.1
	Female	93.2	6.8	<0.001
	Age at Diagnosis
	<30 years old	86.3	13.7	<0.001
	30-39	79.3	20.7	<0.001
	40-49	86.7	13.3	0.475
	50-59	90.7	9.3	<0.001
	60-69	90.1	9.9	<0.001
	≥ 70 years old	87.9	12.1	<0.001
	Decades of Diagnosis
	1982-1991	74.3	25.7	<0.001
	1992-2001	85.1	14.9	<0.001
	2002-2011	94.8	5.2

Table3: Unadjusted and adjusted hazard ratios for Primary Cutaneous Melanoma among U.S adults patients, 1982-2011 (N=185219).
Characteristics	Unadjusted		Adjusted

	HR (95% CI)	p-value	HR (95% CI)	p-value
Race/Ethnicity
White Non-Hisp	Ref		Ref
black non-Hisp	4.3 (4.0-4.5)	<0.001	0.7 (0.6-0.8)	<0.001
Hispanic	2.2 (2.0-2.3)	<0.001	1.1 (0.9-1.2)	0.376
Others	1.8 (1.6-1.9)	<0.001	0.9 (0.8-1.0)	0.033
Stage
In Situ	Ref		Ref
Localized	5.3 (5.0-5.8)	<0.001	5.7 (5.3-6.2)	<0.001
Regional	31.3 (28.8-34.0)	<0.001	31.7 (29.2-34.4)	<0.001
Distant	202.4 (186.2-220.1	<0.001	189.8 (174.4-206.5)	<0.001
Gender
Male	Ref		Ref	<0.001
Female	0.4 (0.3-0.4)	<0.001	0.7 (0.6-0.7)	<0.001
Age at Diagnosis
<30 years old	Ref		Ref	<0.001
30-39	1.6 (1.5-1.7)	<0.001	1.3 (1.1-1.4)	<0.001
40-49	1.1 (1.0-1.1)	0.475	1.6 (1.4-4.7)	<0.001
50-59	0.7 (0.7-0.8)	<0.001	1.9 (1.8-2.1)	<0.001
60-69	0.8 (0.8-0.9)	<0.001	2.4 (2.2-2.6)	<0.001
≥ 70 years old	1.2 (1.1-1.2)	<0.001	3.5 (3.2-3.9)	<0.001
Decades of Diagnosis
1982-1991	3.5 (3.3-3.6)	<0.001	1.6 (1.5-1.7)	<0.001
1992-2001	2.0 (1.9-2.1)	<0.001	1.3 (1.2-1.3)	<0.001
2002-2011	Ref		Ref	<0.001