Association Between Hospital Volume, Therapy Types, and Overall Survival in Stage III and IV Cutaneous Malignant Melanoma

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Background: The advent of targeted therapies and immunomodulatory agents has revolutionized the management of advanced cutaneous malignant melanoma (MMel) by prolonging overall survival. This study evaluated the therapeutic and survival disparities among patients with advanced MMel based on hospital volume using the National Cancer Database (NCDB). Methods: A retrospective analysis using regression models and Kaplan-Meier estimates was performed from the data obtained from the NCDB on patients with MMel diagnosed in 2004 through 2015. Results: A total of 40,676 patients with MMel were treated at 1,260 facilities. Multivariable analysis showed that facility volume was an independent predictor of overall survival (P<.0001). Compared with patients treated at high-volume facilities (tertile 3 [T3]), those with stage III disease (n=27,528) treated at intermediate- and low-volume facilities (T2 and T1, respectively) had a significantly higher risk of death (T2 hazard ratio [HR], 1.15; 95% CI, 1.09–1.20; T1 HR, 1.23; 95% CI, 1.17–1.29). Compared with patients treated at T3 facilities, those with stage IV disease (n=13,148) treated at lower-tertile facilities had a significantly higher risk of death (T2 HR, 1.16; 95% CI, 1.10–1.21; T1 HR, 1.29; 95% CI, 1.23–1.36). Further, patients with stage IV disease treated at T3 facilities (vs T1 facilities) were more likely to receive chemotherapy (38% vs 28%) and immunotherapy (23% vs 10%) (P<.0001). Conclusions: Patients with advanced-stage MMel treated at high-volume facilities had significantly improved survival and were more likely to receive chemotherapy and immunotherapy.

Submitted February 15, 2019; accepted for publication May 16, 2019.Previous presentation: This work was presented at the 2018 ASCO Annual Meeting; June 1–5, 2018; Chicago, Illinois.Author contributions: Study concept and design: Tell, Kommalapati. Data acquisition, analysis, or interpretation: All authors. Manuscript–draft: Kommalapati, Tella. Manuscript–critical revision: All authors. Supervision: Ganti, Marr. Dr. Kommalapati had full access to the study data and takes responsibility for the integrity of the data and the accuracy of the data analysis.Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.Correspondence: Anuhya Kommalapati, MBBS, Department of Oncology, H. Lee Moffitt Cancer Center, Tampa, FL 33612. Email: anuhya781@gmail.com
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