Background

Previous studies of cancer care have demonstrated improved long-term patient outcomes for those treated at high-volume centers. The influence of treatment center characteristics on outcomes for primary nonmetastatic melanoma is not currently established.

Objective

We aimed to investigate the association of cancer treatment center case volume and academic affiliation with long-term patient survival for cases of primary nonmetastatic melanoma.

Methods

Cases of melanoma diagnosed in US adults from 2004 to 2014 and included in the National Cancer Database were identified. Hospitals were grouped by yearly case-volume quartile: bottom quartile, 2 middle quartiles, and top quartile.

Results

Facility case volume was significantly associated with long-term patient survival (P < .0001). The 5-year survival rates were 76.8%, 81.9%, and 86.4% for patients treated at institutions in the bottom, middle, and top quartiles of case volume, respectively. On multivariate analysis, treatment at centers in both middle quartiles (hazard ratio, 0.834; 95% confidence interval, 0.778-0.895) and in the top quartile (hazard ratio, 0.691; 95% confidence interval, 0.644-0.741) of case volume was associated with improved survival relative to that of patients treated at hospitals in the bottom quartile of case volume. Academic affiliation was associated with improved outcomes for top-quartile- but not middle-quartile-volume facilities.

Limitations

Disease-specific survival was not available.

Conclusions

Treatment at a high-volume facility is associated with improved long-term patient survival for melanoma. High-volume academic centers have improved patient outcomes compared with other high-volume centers.

中文翻译：

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在大量学术机构中治疗原发性非转移性黑色素瘤可改善患者的长期生存率

背景

先前的癌症治疗研究表明，那些在大剂量治疗中心接受治疗的患者的长期患者结局得到改善。目前尚无治疗中心特征对原发性非转移性黑色素瘤预后的影响。

客观的

我们旨在调查原发性非转移性黑色素瘤病例的癌症治疗中心病例数量和学术归属与长期患者生存率的关系。

方法

确定了2004年至2014年在美国成年人中诊断出的黑色素瘤病例，并将其纳入了美国国家癌症数据库。医院按年度病例量四分位数分组：最低四分位数，2个中四分位数和最高四分位数。

结果

机构病例数量与患者长期存活率显着相关（P  <.0001）。在病例数的底部，中部和顶部四分位数的机构中接受治疗的患者的5年生存率分别为76.8％，81.9％和86.4％。在多变量分析中，病例数的两个中四分位数（危险比，0.834； 95％置信区间，0.778-0.895）和顶部四分位数（危险比，0.691； 95％置信区间，0.644-0.741）的中心治疗相对于病例数最低的四分位数在医院接受治疗的患者，其生存率得到了改善。学术联系与前四分位数但中四分位数数量设施的改善结果相关。

局限性

没有特定疾病的生存率。

结论

大量治疗可改善黑色素瘤患者的长期生存率。与其他大批量中心相比，大批量学术中心改善了患者的预后。