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Melanoma treatment at high-volume centers improves long-term survival

Treatment for primary nonmetastatic melanoma at high-volume facilities is associated with improved long-term patient survival, with academic centers reporting the best outcomes, according to a study.

To explore the volume-outcome relationship in melanoma care, researchers utilized data from the National Cancer Database, which includes approximately 70% of all newly diagnosed malignancies in the U.S., Michael Girardi, MD, of the department of dermatology at Yale School of Medicine, and colleagues wrote.

Most patients (95.7%) were identified as white and covered under private insurance (58.3%).

Of 1,330 facilities included in the analysis, 191 had an academic affiliation.

Within the academic centers, 59.7% were within the top quartile of case volume, and in other centers, 19.5% were within the top quartile of case volume, the researchers reported.

Seventy-five percent of patients were treated at facilities that treated 33 or fewer patients with melanoma per year, with 25% of patients treated at facilities that treated fewer than seven patients per year and 50% at facilities with yearly case volumes between seven and 33 cases of melanoma, according to the researchers.

Significantly improved survival was found in patients treated at middle-quartile-volume (MQV) facilities vs. at bottom-quartile-volume (BQV) facilities.

Additionally, top-quartile-volume (TQV) facilities showed significantly improved survival for patients compared with MQV facilities.

At BQV facilities, 3-, 5- and 10-year survival rates of 84.1%, 76.8% and 62.6%, respectively, were reported.

At MQV facilities, 3-year survival rates were 88.4%, 5-year rates were 81.9% and 10-year rates were 68.6%, and in TQV facilities, the survival rates were 91.7%, 86.4% and 75.1%, respectively, according to the study.

“We demonstrated that patients treated at TQV facilities exhibited improved survival,” the researchers wrote.

The proportion of both black and Hispanic patients treated at TQV facilities were smaller than at BQV facilities. Additionally, more patients treated at TQV facilities had private insurance than those treated at MQV and BQV facilities, they wrote.

“We found that academic institutions did not show improved outcomes within MQV institutions, but within TQV institutions, treatment at an academic center was associated with significantly improved survival,” Girardi and colleagues wrote.

They concluded that the further shifting of patient care toward high-volume facilities may improve overall survival of melanoma patients. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.