Male or female sex stratified by age does not impact survival in patients with metastatic melanoma receiving immunotherapy.
Publication Title
American journal of surgery
Document Type
Article
Publication Date
1-1-2026
Keywords
Humans; Melanoma; Male; Female; Middle Aged; Sex Factors; Immunotherapy; Age Factors; Adult; Aged; Skin Neoplasms; Young Adult; Survival Rate; Adolescent; Retrospective Studies; United States; Neoplasm Staging; Databases, Factual; Prognosis; california; santa monica; sjci; montana; missoula
Abstract
BACKGROUND: Increasing age and male sex are associated with worse prognosis in melanoma. Here, we evaluated outcomes in stage IV melanoma patients who received immunotherapy, stratified by sex and age.
METHODS: The National Cancer Database (NCDB) was queried to identify patients with stage IV melanoma (n = 20023) with or without first-course immunotherapy from 2012 to 2019.
RESULTS: 67.7 % of patients were male, and 44.2 % received immunotherapy. On multivariable analysis, when compared to males, female patients had improved survival without immunotherapy (HR 0.90, p < 0.001), but survival was equivalent with immunotherapy (HR 0.95, p = 0.106). The benefit of immunotherapy was smaller in females compared to males overall (HR 1.08, p = 0.039), and greater in patients aged 45-60 years (HR 0.82, p = 0.006) or >60 years (HR 0.84, p = 0.008), relative to 18-44-year-olds.
CONCLUSIONS: Survival outcomes between male and female metastatic melanoma patients were equivalent when receiving immunotherapy. The benefit of immunotherapy was greatest in those aged >45 years, regardless of sex.
Area of Special Interest
Cancer
Specialty/Research Institute
Oncology
Specialty/Research Institute
Dermatology
DOI
10.1016/j.amjsurg.2025.116710
