Purpose: This study aimed to analyze the incidence trend and further explore the risk factors influencing survival among patients with malignant skin cancer in America. Methods: Age-adjusted incidence rates, annual percentage change (APC) of different sexes and ethnicities in 1973-2015 and patient records were extracted from the Surveillance, Epidemiology and End Results (SEER) database. Univariate analysis and multivariate Cox regression were used to analyze the risk factors influencing the survival of skin cancer patients. Survival curves and nomograms were constructed to evaluate the survival prediction of R. Results: The overall age-adjusted incidence of skin cancer increased in the United States from 1973 to 2005 (APC = 2.8%, 95% CI: 2.6–2.9%, P < 0.05), particularly in white patients, people aged 66 years, and males. The 3- and 5-year overall survival (OS) rates were 51.4% and 33.8%, respectively. Independent predictors for short OS included age over 65 years, white ethnicity, other marital status, and no surgery (P < 0.05). Stage was not an independent survival factor (P > 0.05). The nomogram with a C-index of 0.72 (95% CI: 0.71– 0.73) was consistent with an adequate calibration curve. Conclusion: Our study demonstrated incidence trends of malignant skin cancer and constructed a nomogram to predict its long-term survival based on the SEER database. In general, the incidence of CS was increasing , higher in the male and white population. The nomogram, which showed high precision and consistency, selected several variables associated with skin cancer survival: age, ethnicity, marital status, and surgical history. It showed that the nomogram was an effective tool for predicting prognosis. The incidence of skin cancer in the United States increased during 1973–2015 according to the SEER database. Age, ethnicity, marital status, and surgical history were associated with malignant skin cancer survival. |
Age-adjusted skin cancer incidence rate in 2004-2015. Notes: Stratified by total (A), sex (B), ethnicity (C).
Comments
The 5-year survival rate during the time period was only 33.8%, the study found.
The incidence of skin cancer in the United States increased steadily between 1973 and 2015, according to a new report, particularly among men, white people and people over 65 years of age. Over the 4-decade study period, skin cancer rates increased 2.8% each year.
The study, published in the International Journal of General Medicine, is based on an analysis of the Surveillance, Epidemiology, and End Results (SEER) database .
The authors noted that studies from around the world have suggested that skin cancer rates are increasing and that this problem is confounded by the high recurrence rate among cancer patients. Despite a significant amount of existing research, researchers said little research has been done on long-term skin cancer occurrence and survival trends in the United States. Therefore, they sought to use the SEER database to find out if trends in the United States are similar to those in other countries and regions.
The researchers identified cases in the database in which skin cancer was pathologically confirmed and demographic data were available. Patients were excluded if their skin cancer was not malignant or if their records had incomplete data.
Overall, 3,551 cases of skin cancer were identified and 1,080 of the patients died from their cancer. After adjusting for age, the authors found an overall incidence of 27.9 cases per 100,000 people in 2015 versus 7.4 per 100,000 cases in 1973.
Both men and women experienced significant annual percentage changes, although the increase was steeper in men than women (3.1% vs. 2.4%). Similarly, white individuals saw an increase from 8.1 cases per 100,000 in 1973 to 34.7 per 100,000 in 2015, an annual percentage change of 3.1% versus just 0.3% in the black population and 1.4% for other ethnicities.
Although the incidence of skin cancer changed over time, the researchers found that survival rates did not appear to be correlated with the year the patient received their diagnosis. Overall, the 3-year survival rate was 51.4% in the patients studied and the 5-year survival rate was 33.8%. Risk factors for mortality included being white, male and older than 66, the analysis showed.
The authors said their analysis of trends in the United States aligns with reports from other regions and offered some possible explanations for the increased incidence.
“It could be the result of increased awareness of physical examination, access to medical care and screening methods, and cumulative exposure to intense and complex sunlight,” they wrote.
The difference in incidence between men and women may be due to higher rates of sun exposure due to different social norms or perhaps because women pay more attention to skin care and protection, the authors suggested. That white people have a higher risk of skin cancer is not a new observation, the researchers said, as European ancestry and light skin have long been established as risk factors for skin cancer.
The researchers concluded that skin cancer prevention efforts should be tailored to higher risk groups.
“In view of the increasing incidence of malignant skin cancer and the significant difference between sex and ethnicity, the primary focus should be on men and whites,” they wrote. “Daily skin care protection and early clinical detection will be recommended to prevent malignant skin cancer.”
