As people age, the pattern, timing and extent of distant metastasis change and should be considered when treating melanoma.
“It has become increasingly evident that tumor progression is not solely determined by cell-intrinsic mechanisms but also by factors and nonmalignant cells in the tumor microenvironment that can exert inhibitory or promoting effects on metastasis formation and underlie age-related changes,” according to Maximilian Gassenmaier, MD, of the department of dermatology at Eberhard-Karls-University of Tübingen, Tübingen, Germany, and colleagues.
From the German Central Malignant Melanoma Registry, 1,457 patients with invasive cutaneous melanoma who presented with stage IA to IIC disease at primary diagnosis and developed stage IV disease were analyzed. A pooled cohort included 1,682 patients from five German centers from the registry with identical inclusion and exclusion criteria.
Patients had a median age of 57 years at melanoma diagnosis, with a median follow-up of 50 months.
According to Gassenmaier and colleagues, increasing age was linked with fewer metastatic sites, a higher quantity of stage M1b disease and a lower proportion of stage M1d disease.
Elderly patients had a decreasing rate of distant metastases in all of the organ sites investigated except lung metastasis.
Additionally, patients aged older than 60 years had a shorter follow-up time after stage 4 diagnosis compared with patients aged 60 years or younger (8 months vs. 10 months). However, the researchers reported no link between length of follow-up and the number of metastatic sites.
Within 1 month after stage IV diagnosis, 40.5% of patients aged 50 years or younger compared with 63% of those aged older than 70 years developed the final number of metastatic sites.
Compared with men and patients aged 50 years and younger, women (OR = 0.75; 95% CI, 0.58 to 0.97) and patients older than 70 years (OR = 0.39; 95% CI, 0.28 to 0.55) had a significantly lower risk for multiple metastatic sites.
In conclusion, elderly patients with melanoma had a shorter distant metastasis-free survival but a lower number of metastatic sites compared with younger patients.
“The synchronized occurrence of distant metastasis in elderly patients enables an early assessment of the final disease stage and provides a good basis for decision-making regarding treatment,” the researchers wrote. – by Abigail Sutton
Disclosures: The authors report no relevant financial disclosures.