Shah Areeb, Luong Peter Q, Smith Joshua B, Simpson Matthew, Massa Sean T
Saint Louis University School of Medicine St. Louis MO USA.
Department of Otolaryngology-Head and Neck Surgery Saint Louis University School of Medicine St. Louis MO USA.
Laryngoscope Investig Otolaryngol. 2025 Aug 7;10(4):e70232. doi: 10.1002/lio2.70232. eCollection 2025 Aug.
To evaluate the relationship between socioeconomic status (SES) and the use of immunotherapy (IT) in patients with head and neck mucosal melanoma (HNMM); and to assess trends in 3-year overall survival (OS) associated with IT.
This retrospective study used National Cancer Database (NCDB) data from 2004 to 2021. SES was assessed using a composite measure incorporating race, ethnicity, insurance status, and rural residence. Trends in IT use and OS were evaluated using Joinpoint analysis. Multivariable logistic regression and Cox proportional hazards models assessed associations between SES, IT receipt, and OS. Sensitivity analyses were performed by SES components and time period.
Among 3163 patients, 22.7% received IT. Use of IT increased over time (2013-2021 AAPC: 21.9%, 95% CI: 19.6-26.9) without significant differences between SES groups. SES was not associated with IT receipt (aOR: 1.15; 95% CI: 0.84-1.55) or OS (aHR: 0.94; 95% CI: 0.78-1.13). IT was not associated with improved OS (aHR: 1.05; 95% CI: 0.87-1.26).
Despite increasing IT use, no disparities in access or survival by SES were observed. While survival improved modestly over time, IT was not independently associated with this trend. These findings highlight equitable IT use in HNMM and underscore the need for future prospective studies to clarify its survival impact.
评估社会经济地位（SES）与头颈部黏膜黑色素瘤（HNMM）患者免疫治疗（IT）使用之间的关系；并评估与IT相关的3年总生存期（OS）趋势。
这项回顾性研究使用了2004年至2021年的国家癌症数据库（NCDB）数据。SES通过综合种族、民族、保险状况和农村居住情况进行评估。使用Joinpoint分析评估IT使用和OS的趋势。多变量逻辑回归和Cox比例风险模型评估SES、接受IT治疗和OS之间的关联。按SES组成部分和时间段进行敏感性分析。
在3163例患者中，22.7%接受了IT治疗。IT的使用随时间增加（2013 - 2021年年度百分比变化率：21.9%，95%置信区间：19.6 - 26.9），SES组之间无显著差异。SES与接受IT治疗无关（调整后比值比：1.15；95%置信区间：0.84 - 1.55）或与OS无关（调整后风险比：0.94；95%置信区间：0.78 - 1.13）。IT与OS改善无关（调整后风险比：1.05；95%置信区间：0.87 - 1.26）。
尽管IT的使用有所增加，但未观察到SES在获取或生存方面的差异。虽然生存率随时间略有改善，但IT与这一趋势无独立关联。这些发现突出了HNMM中IT使用的公平性，并强调需要未来进行前瞻性研究以阐明其对生存的影响。
