The utilization of concurrent immunotherapy and its impact on overall survival among late-stage melanoma patients treated by surgery: a query on the National Cancer Database 公开
Li, Yiman (Spring 2019)
Abstract
Background: Melanoma is a type of cancer that can develop quickly from skin to body. Stage III or IV melanoma patients, a combination therapy of immunotherapy and surgery provide anti-cancer benefits and improve patients overall survival. Surgery is a primary treatment to remove parts or whole tumor. The main goal of this study is to examine the utilization of immunotherapy in addition to surgery among late-stage melanoma patients regarding their socioeconomic status and to verify the impact of the concurrent immunotherapy and surgery on overall survival.
Methods: 23454 eligible melanoma patients (≥18 years) with stage III or IV who diagnosed in 2004-2012 in NCDB. The overall survival was the primary outcome defined as months from the date of surgery to death or last follow-up. We used univariate analysis (UVA)/ multivariable analysis (MVA) Cox proportional hazard regression model, and Kaplan-Meier (KM) method for overall survival estimation by comparing combination therapy and surgery group. The numerical and categorical covariates were examined by ANOVA and Chi-square test, and multivariable logistic regression model was used to predict the usage of immunotherapy. The subgroup analyses were carried out by including an interaction term in MVA models.
Results: 6193 (26.4%) patients got concurrent immunotherapy vs.17261 (73.6%) received no immunotherapy subjects were 62% male and 96.8% white with a median age of 57 years. Patients accepted immunotherapy were more likely to be male, white, to receive private insurance, to live in the areas with higher income and education, to live in a metro area, to be diagnosed in more recent years. In the UVA, the concurrent immunotherapy was significantly associated with prolonged overall survival (HR=0.59, 95% CI=0.57-0.62, p<0.001) compared to no immunotherapy, and such benefit did not differ much by disease stage (p-value=0.492).
Conclusion: In this study, melanoma patients treated with immunotherapy plus surgery had significantly better survival than surgery only patients. The opportunity of to be benefited from the immunotherapy is more located among the population with higher socioeconomic status. The results may indicate the need for related policy development that leads to more accessible for this treatment.
Table of Contents
Table of Contents
1. Introduction……………………………………………………………………...1
2. Materials and methods………………………………………………...……..3
2.1 Data source and patient selection……..……………………………….…....3
2.2 Definition of treatment cohorts, covariate, outcome……….…..………3
2.3 Statistical methods……………………………………………………..……..…4
2.3.1 Descriptive analysis…………………………………………………..…..4
2.3.2 Bivariate analysis……………………………………………...…………..4
2.3.3 Survival analysis………………………………….…………...…………..4
2.3.4 Multivariable Logistics analysis…………………………...…..……...5
3. Results……………………………………………………………………….……5
3.1 Patients’ characteristics overall or by comparison group….………….5
3.2 Regression analysis…………………………………………………….…........6
3.2.1 Univariate analysis…………………………………………..………...…7
3.2.2 Multivariable survival analysis…………..……………..………....….7
3.2.3 Multivariable logistic regression analysis……………...……....….9
3.3 Association with overall survival………………………….………………...9
4. Discussion……………………………………………………..…...………….10
5. Conclusion…………………………...………………………...……………...13
6. Reference……………………………………………………………...………..14
7. Tables and figures…………………………..………………………………..16
About this Master's Thesis
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The utilization of concurrent immunotherapy and its impact on overall survival among late-stage melanoma patients treated by surgery: a query on the National Cancer Database () | 2019-04-08 13:42:55 -0400 |
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Thesis (Original File) | 2019-04-08 13:42:58 -0400 |
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