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Melanoma prognosis in Europe: Far from equal

par Forsea, Ana-Maria;Del Marmol, Véronique ;Stratigos, Alexander;Geller, Alan
Référence British journal of dermatology, 171, 1, page (179-182)
Publication Publié, 2014

Article révisé par les pairs

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Résumé :

Background Comprehensive, population-based analysis of melanoma survival throughout Europe is hindered by the uneven coverage and quality of European cancer registries, and by logistical and financial shortcomings. Mortality-to-incidence ratios (MIRs) have been used as a proxy for estimating survival for multiple cancers and to model melanoma prognosis, higher MIR values reflecting poorer prognosis. Updated and improved pan-European estimates of mortality and incidence rates for melanoma have become available through the International Agency for Research of Cancer project Globocan 2008, showing marked differences among European countries. Objectives To analyse MIRs for melanoma across Europe and their relationship with national health expenditures, aiming to identify countries and regions with disproportionately poor prognosis. Methods Estimated age-standardized rates of melanoma incidence and mortality provided by Globocan 2008 were used to calculate the MIR for each European country and region. Total health expenditures per capita in European countries for 2008 were provided by the World Health Organization/Global Health Observatory. The potential correlation between MIR and total health expenditure per capita was analysed through Pearson's correlation. Results Mortality-to-incidence ratios for melanoma ranged between 0·09 in Switzerland and 0·44 in Latvia. The regional average MIR was the highest in Central and Eastern Europe at 0·35; the lowest was in Western Europe, at 0·13. We found a strong inverse correlation between the individual nation's total health expenditure per capita and the calculated melanoma MIR (r = -0·76, P < 0·05). Conclusions While further improvement of melanoma registration is necessary, our findings reveal sharp disparities in the prognosis of melanoma across the Continent, correlated with significant differences in health care expenditures. What's already known about this topic? No comprehensive analysis of melanoma survival is available for the whole European continent. Mortality-to-incidence ratios (MIR) have been used to estimate survival for multiple cancers and to model melanoma prognosis. What does this study add? This is the first pan-European estimate of melanoma prognosis based on MIRs, revealing wide variation across Europe. Central and Eastern Europe had the highest MIR values, reflecting the poorest prognosis. Melanoma prognosis, modelled through MIR, correlated strongly with national health expenditures. © 2014 British Association of Dermatologists.