Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Ann Surg Oncol. 2023 Jun;30(6):3634-3645. doi: 10.1245/s10434-023-13341-6. Epub 2023 Mar 19.
Minority-serving hospitals (MSHs) have been associated with lower guideline adherence and worse outcomes for various cancers. However, the relationship among MSH status, concordance with sentinel lymph node biopsy (SLNB) guidelines, and overall survival (OS) for patients with cutaneous melanoma is not well studied.
The National Cancer Database was queried for patients diagnosed with T1a*, T2, and T3 melanoma between 2012 and 2017. MSHs were defined as the top decile of institutions ranked by the proportion of minorities treated for melanoma. Based on National Comprehensive Cancer Network guidelines, guideline-concordant care (GCC) was defined as not undergoing SLNB if thickness was < 0.76 mm without ulceration, mitosis ≥ 1/mm, or lymphovascular invasion (T1a*), and performing SLNB for patients with intermediate thickness melanomas between 1.0 and 4.0 mm (T2/T3). Multivariable logistic regressions examined associations with GCC. The Kaplan-Meier method and log-rank tests were used to evaluate OS between MSH and non-MSH facilities.
Overall, 5.9% (N = 2182/36,934) of the overall cohort and 37.8% of minorities (n = 199/527) were managed at MSHs. GCC rates were 89.5% (n = 33,065/36,934) in the overall cohort and 85.4% (n = 450/527) in the minority subgroup. Patients in the overall cohort (odds ratio [OR] 0.85; p = 0.02) and the minority subgroup (OR 0.55; p = 0.02) were less likely to obtain GCC if they received their care at MSHs compared with non-MSHs. Minority patients receiving care at MSHs had a decreased survival compared with those treated at non-MSHs (p = 0.002).
Adherence to SLNB guidelines for melanoma was lower at MSHs. Continued focus is needed on equity in melanoma care for minority patients in the United States.
少数族裔服务医院（MSHs）与各种癌症的指南遵循率较低和结局较差有关。然而，对于皮肤黑色素瘤患者，MSH 状态、与前哨淋巴结活检（SLNB）指南的一致性以及总生存（OS）之间的关系尚未得到充分研究。
国家癌症数据库（National Cancer Database）查询了 2012 年至 2017 年间诊断为 T1a*、T2 和 T3 黑色素瘤的患者。MSHs 被定义为接受黑色素瘤治疗的少数族裔比例最高的前十分位机构。根据国家综合癌症网络指南，如果厚度<0.76mm 且无溃疡、有丝分裂≥1/mm2 或淋巴血管侵犯（T1a*），则不进行 SLNB，如果是 1.0 至 4.0mm（T2/T3）之间的中间厚度黑色素瘤，则进行 SLNB，则认为符合指南（GCC）。多变量逻辑回归检查与 GCC 的关联。Kaplan-Meier 法和对数秩检验用于评估 MSH 和非 MSH 设施之间的 OS。
总体而言，5.9%（N=2182/36934）的总体队列和 37.8%的少数民族（n=199/527）在 MSH 接受治疗。GCC 率在总体队列中为 89.5%（n=33065/36934），在少数民族亚组中为 85.4%（n=450/527）。与非 MSH 相比，在总体队列（比值比 [OR] 0.85；p=0.02）和少数民族亚组（OR 0.55；p=0.02）中，接受 MSH 治疗的患者获得 GCC 的可能性较小。与在非 MSH 接受治疗的患者相比，在 MSH 接受治疗的少数民族患者的生存率降低（p=0.002）。
MSH 处黑色素瘤的 SLNB 指南遵循率较低。美国需要继续关注少数族裔黑色素瘤患者的医疗公平性。
