Hospital Universitario Virgen Macarena, Seville, Spain.
Hospital Universitario Virgen Macarena, Seville, Spain.
J Am Acad Dermatol. 2014 Sep;71(3):507-15. doi: 10.1016/j.jaad.2014.04.049. Epub 2014 Jun 2.
The prognostic benefit of health care service provision and delivery policies for patients with malignant melanoma (MM) is not yet clear.
To analyze the role of health care provision determinants in the initial prognosis of MM.
A multicenter cross-sectional study was conducted at 14 public hospitals and recruited 3550 patients with MM between 2000 and 2009. The study variables were analyzed using univariate and multivariate models to identify their role in the variations observed.
In a 10-year period, the number of patients with MM increased by 78.54%, with primary in situ MM (Tis) or MMs with a Breslow thickness <1 mm (T1) representing 51.72% of the total number of MMs in 2000, increasing to 62.23% by the end of the study period (P = .005). Among the variables that explained the variation in MM frequency the year of diagnosis after 2004 (univariate odds ratio [OR], 1.43 [P < .001]; multivariate OR, 1.36 [P = .005]) and diagnosis in centers with specific fast-track referral systems (univariate OR, 1.24 [P = .01]; multivariate OR, 1.59 [P = .025]) were shown to explain the increasing frequency of Tis-T1 MM.
The primary potential limitation of this study is its retrospective nature.
Health care provision policies and interventions aimed at improving accessibility to specialized care appear to explain the increasing frequency of Tis-T1 MM.
医疗服务提供和交付政策对恶性黑素瘤（MM）患者的预后获益尚不清楚。
分析医疗保健提供决定因素在 MM 初始预后中的作用。
在 14 家公立医院进行了一项多中心横断面研究，招募了 2000 年至 2009 年间的 3550 名 MM 患者。使用单变量和多变量模型分析研究变量，以确定它们在观察到的变化中的作用。
在 10 年期间，MM 患者的数量增加了 78.54%，2000 年总 MM 中 51.72%为原位 MM（Tis）或厚度<1mm 的 MM（T1），到研究结束时增加到 62.23%（P=0.005）。在解释 MM 发病率变化的变量中，2004 年后诊断的年份（单变量优势比[OR]，1.43[P<0.001]；多变量 OR，1.36[P=0.005]）和具有特定快速转诊系统的中心诊断（单变量 OR，1.24[P=0.01]；多变量 OR，1.59[P=0.025]）被证明可以解释Tis-T1 MM 发病率的增加。
这项研究的主要潜在局限性是其回顾性。
旨在改善获得专科护理的机会的医疗保健提供政策和干预措施似乎可以解释Tis-T1 MM 发病率的增加。
