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Treatment of primary nonmetastatic melanoma at high-volume academic facilities is associated with improved long-term patient survival - 14/03/19

Doi : 10.1016/j.jaad.2018.10.026 
Shayan Cheraghlou, BA a, George O. Agogo, PhD b, Michael Girardi, MD a,
a Department of Dermatology, Yale School of Medicine, New Haven, Connecticut 
b Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut 

Correspondence to: Michael Girardi, MD, 333 Cedar St, PO Box 208059, Department of Dermatology, Yale University School of Medicine, New Haven, CT 06520.Department of DermatologyYale University School of Medicine333 Cedar St, PO Box 208059New HavenCT06520

Abstract

Background

Previous studies of cancer care have demonstrated improved long-term patient outcomes for those treated at high-volume centers. The influence of treatment center characteristics on outcomes for primary nonmetastatic melanoma is not currently established.

Objective

We aimed to investigate the association of cancer treatment center case volume and academic affiliation with long-term patient survival for cases of primary nonmetastatic melanoma.

Methods

Cases of melanoma diagnosed in US adults from 2004 to 2014 and included in the National Cancer Database were identified. Hospitals were grouped by yearly case-volume quartile: bottom quartile, 2 middle quartiles, and top quartile.

Results

Facility case volume was significantly associated with long-term patient survival (P < .0001). The 5-year survival rates were 76.8%, 81.9%, and 86.4% for patients treated at institutions in the bottom, middle, and top quartiles of case volume, respectively. On multivariate analysis, treatment at centers in both middle quartiles (hazard ratio, 0.834; 95% confidence interval, 0.778-0.895) and in the top quartile (hazard ratio, 0.691; 95% confidence interval, 0.644-0.741) of case volume was associated with improved survival relative to that of patients treated at hospitals in the bottom quartile of case volume. Academic affiliation was associated with improved outcomes for top-quartile- but not middle-quartile-volume facilities.

Limitations

Disease-specific survival was not available.

Conclusions

Treatment at a high-volume facility is associated with improved long-term patient survival for melanoma. High-volume academic centers have improved patient outcomes compared with other high-volume centers.

Le texte complet de cet article est disponible en PDF.

Key words : case volume, melanoma, NCDB, outcomes, survival

Abbreviations used : BQV, CI, HR, IL-2, MQV, NCDB, SE, TQV


Plan


 Funding sources: Supported by the Leon Rosenberg, MD, Medical Student Research Fund in Genetics and the Jane Danowski Weiss Family Foundation Fellowship. The funders had no role in the present study.
 Conflicts of interest: None disclosed.
 Reprints not available from the authors.


© 2018  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 80 - N° 4

P. 979-989 - avril 2019 Retour au numéro
Article précédent Article précédent
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