gms | German Medical Science

Introduction: Since 2011, new treatment options specifically for prognostically unfavorable cutaneous melanoma are available, such as immunotherapies and targeted agents. Randomized controlled trials report improvements in survival, but it is unclear if beneficial effects are also appearing on the population-level.

Methods: All patients with melanoma diagnosis (ICD10: C43) in 2000-19 were included from population-based cancer registries. Five-year relative survival (5YRS) was calculated for four five-year periods (2000-04, 2005-09, 2010-14, 2015-19). In addition, the 5YRS in 2010-19 was calculated for the federal states. To correct for temporal and regional differences in sex, age groups and UICC stage, standardization/stratification was performed. Regression modelling was used to capture significance (p<0.05) of an expected time trend in Germany. As an additional step, this method will be transferred to the federal states in order to make more differentiated statements on temporal trends and to investigated regional differences.

Results: We included 301,486 patients. The 5YRS improved from 93% (2000-04) to 95% (2015-19) and in almost all investigated subgroups. The largest increases occurred from 2010-14 to 2015-19, and there in advanced melanoma, with 5YRS for stage UICC IV melanoma increasing from 31% to 36% (relative difference +16%). The overall survival trend over all time periods showed a significant improvement. The 5YRS in 2010-19 varied from 90% to 96% across the federal states.

Conclusion: In addition to new targeted therapies, other factors in care and treatment, such as changes in registration or the introduction of the national skin screening program, could have an impact on survival. However, our analyses attempted to correct for these influences, for example by stage and age standardization or stage-specific analyses.

Over the past 20 years, survival of melanoma patients improved significantly. The largest improvements were seen for advanced tumor stages from 2010-14 to 2015-19. This development strongly supports that the positive effects of new therapies, already observed in several RCTs, are also evident on population-based level after their approval.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.

The contribution has already been published: [1]