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
Publication statusPublished - 1 Feb 2021


  • advanced melanoma
  • combined nivolumab
  • double-blind
  • immunotherapy
  • ipilimumab
  • iv melanoma
  • metastatic melanoma
  • nationwide
  • pembrolizumab
  • phase-iii trials
  • pooled analysis
  • population-based
  • progression-free
  • real-world
  • targeted therapy
  • vemurafenib
  • Targeted therapy
  • Real-world
  • Advanced melanoma
  • Nationwide
  • Population-based
  • Immunotherapy

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