皮肤头颈黑色素瘤的病例量区域化及基于病例量的结局差异

Case volume regionalization and volume-based outcome differences in cutaneous head and neck melanoma.

作者信息

Roman Kelsey M, Torabi Sina J, Goshtasbi Khodayar, Kuan Edward C, Tjoa Tjoson, Haidar Yarah M

机构信息

Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA.

出版信息

Head Neck. 2022 Nov;44(11):2428-2436. doi: 10.1002/hed.27150. Epub 2022 Jul 29.

DOI:10.1002/hed.27150

PMID:35903986

Abstract

BACKGROUND

Hospital volume has emerged as a prognostic factor in oncology but is not currently known whether volume is associated with improved outcomes for cutaneous head and neck (HN) melanoma.

METHODS

A total of 556 079 cutaneous melanoma cases reported by the 2004-2016 National Cancer Database were separated into two cohorts (HN and non-HN) and facilities within each cohort were classified by case volume. Analysis employed chi-square, analysis of variance, Kaplan-Meier, and Cox proportional hazards models.

RESULTS

Only 41 facilities (3.1% of 1326) treating HN melanoma and 50 facilities (3.7% of 1344) treating non-HN melanoma were classified as high-volume facilities (HVFs). The estimated 5-year overall survival (OS) was 62.7% (standard error [SE]: 0.4%) for patients with HN at low-volume facilities (LVFs), 69.3% (SE: 0.4%) at IVFs, and 71.8% (SE 0.4%) at HVFs (p < 0.001). Differences in OS remained significant between HVFs versus LVFs after adjusting for confounders.

CONCLUSION

Volume is independently associated with OS and improved surgical outcomes for HN melanoma.

摘要

背景

医院规模已成为肿瘤学中的一个预后因素，但目前尚不清楚规模是否与头颈部皮肤（HN）黑色素瘤的预后改善相关。

方法

将2004 - 2016年国家癌症数据库报告的总共556079例皮肤黑色素瘤病例分为两个队列（HN和非HN），并根据病例数量对每个队列中的医疗机构进行分类。分析采用卡方检验、方差分析、Kaplan - Meier法和Cox比例风险模型。

结果

治疗HN黑色素瘤的机构中只有41家（占1326家的3.1%）和治疗非HN黑色素瘤的机构中只有50家（占1344家的3.7%）被归类为高容量机构（HVF）。低容量机构（LVF）中HN患者的估计5年总生存率（OS）为62.7%（标准误[SE]：0.4%），中等容量机构（IVF）中为69.3%（SE：0.4%），高容量机构（HVF）中为71.8%（SE 0.4%）（p < 0.001）。在调整混杂因素后，HVF与LVF之间的OS差异仍然显著。