Survival outcomes of patients with advanced melanoma from 2013 to 2017: Results of a nationwide population-based registry

M C T van Zeijl, L C de Wreede, A J M van den Eertwegh, M W J M Wouters, A Jochems, M G Schouwenburg, M J B Aarts, A C J van Akkooi, F W P J van den Berkmortel, J W B de Groot, G A P Hospers, E Kapiteijn, D Piersma, R S van Rijn, K P M Suijkerbuijk, A J Ten Tije, A A M van der Veldt, G Vreugdenhil, J J M van der Hoeven, J B A G Haanen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: The treatment landscape has completely changed for advanced melanoma. We report survival outcomes and the differential impact of prognostic factors over time in daily clinical practice.

Methods: From a Dutch nationwide population-based registry, patients with advanced melanoma diagnosed from 2013 to 2017 were analysed (n = 3616). Because the proportional hazards assumption was violated, a multivariable Cox model restricted to the first 6 months and a multivariable landmark Cox model from 6 to 48 months were used to assess overall survival (OS) of cases without missing values. The 2017 cohort was excluded from this analysis because of the short follow-up time.

Results: Median OS of the 2013 and 2016 cohort was 11.7 months (95% confidence interval [CI]: 10.4-13.5) and 17.7 months (95% CI: 14.9-19.8), respectively. Compared with the 2013 cohort, the 2016 cohort had superior survival in the Cox model from 0 to 6 months (hazard ratio [HR] = 0.55 [95% CI: 0.43-0.72]) and in the Cox model from 6 to 48 months (HR = 0.68 [95% CI: 0.57-0.83]). Elevated lactate dehydrogenase levels, distant metastases in >= 3 organ sites, brain and liver metastasis and Eastern Cooperative Oncology Group performance score of >= 1 had stronger association with inferior survival from 0 to 6 months than from 6 to 48 months. BRAF-mutated melanoma had superior survival in the first 6 months (HR = 0.50 [95% CI: 0.42-0.59]).

Conclusion(s): Prognosis for advanced melanoma in the Netherlands has improved from 2013 to 2016. Prognostic importance of most evaluated factors was higher in the first 6 months after diagnosis. BRAF-mutated melanoma was only associated with superior survival in the first 6 months. (C) 2020 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)242-251
Number of pages10
JournalEuropean Journal of Cancer
Early online date26-Dec-2020
Publication statusPublished - Feb-2021


  • Advanced melanoma
  • Immunotherapy
  • Targeted therapy
  • Real-world
  • Nationwide
  • Population-based

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