Results of an EORTC study recently published in The Journal of Clinical Oncology show that gender is an independent prognostic indicator for progression and survival in patients with advanced stage metastatic melanoma. A previous EORTC study had already shown that women have a consistent and independent advantage in all aspects of the progression of localized (stage I and II) melanoma, and these new results confirm this difference between the sexes exists for metastatic (stages III and IV) melanoma, as well.
Dr. Arjen Joosse from the Department of Public Health at Erasmus University Medical Center in Rotterdam, the Netherlands, and lead author of this study says, “The importance of our study is that it shows that the female survival advantage persists in melanoma even as it metastasizes to distant organs; it remains independent of all other prognostic indicators. This strongly suggests an underlying biological mechanism instead of a behavioral explanation“.
This study analyzed data from five randomized trials conducted by the EORTC Melanoma Group: three adjuvant stage III trials, EORTC trials 18871, 18952 and 18991, and two stage IV trials, EORTC trials 18951 and 18032. In 2734 patients with stage III melanoma, the five year disease-specific survival rate was 51.5% for women and 43.3% for men (the adjusted Hazard ratio was 0.85, 95% CI 0.76-0.95, for disease-specific survival and 0.86, 95% CI 0.77-0.95 for progression-free survival). Women also had a higher disease-specific survival rate among the 1306 patients with stage IV melanoma. The two year disease-specific survival rate for females was 19.0%, and that for men was 14.1% (the adjusted Hazard ratio was 0.81, 95% CI 0.72-0.92 for disease-specific survival and 0.79, 95% CI 0.70-0.88 for progression-free survival).
Even when premenopausal, menopausal, and postmenopausal age categories were considered, this female advantage persisted. It was also seen in various prognostic subgroups, and the authors conclude that a biological difference, rather than a behavioral one, is the likely cause for the observed higher disease-specific and progression-free survival rates among women as compared to men.
This research project was supported by Fonds Cancer (FOCA) from Belgium and an educational grant from the EORTC Melanoma Group.
John Bean, PhD
EORTC Medical Science Writer
On behalf of the EORTC Melanoma Group