TY - JOUR
T1 - Comorbidity burden on receipt of adjuvant immunotherapy and survival in patients with stage III melanoma
T2 - an analysis of the National Cancer Database
AU - Freeman, S. Caleb
AU - Satish, Mohan
AU - Walters, Ryan W.
N1 - Funding Information:
This study was supported by the Creighton University School of Medicine M1 Summer Research Program. A portion of this project was presented at the 13th annual meeting of the Association of VA Hematology/Oncology (AVAHO). The authors would like to thank Peter T. Silberstein, MD, and Mark A. Williams, PhD, for their thoughtful comments on earlier drafts of this work. Any errors are the sole responsibility of the authors.
Publisher Copyright:
© 2020 the International Society of Dermatology
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Background: Comorbidity burden is associated with development of cancer, stage at diagnosis, and treatment outcomes. We evaluated the association between comorbidity burden, receipt of adjuvant immunotherapy, and survival in patients with stage III melanoma. Methods: Using the National Cancer Database, we identified 16,906 patients with stage III melanoma who underwent surgery of the primary site. Outcomes included receipt of adjuvant immunotherapy and overall survival; independent variables included Charlson/Deyo comorbidity index (CDI) and receipt of adjuvant immunotherapy. Results: Patients with CDI scores of two or more averaged 30.0% and 30.9% lower adjusted odds of receiving adjuvant immunotherapy relative to patients with a CDI score of zero or one, respectively (P = 0.001 and 0.002, respectively). Longer survival was associated with lower CDI scores (all P < 0.001) and receipt of adjuvant immunotherapy (P < 0.001). Patients who received adjuvant immunotherapy averaged 16.0% lower adjusted risk of death compared to patients who did not (P < 0.001), which was constant within all CDI cohorts. Patients with a CDI score of two or more averaged 53.4% and 39.1% higher adjusted risk of death relative to patients with a CDI score of zero or one (both P < 0.001). Conclusion: Greater comorbidity burden was associated with lower receipt of adjuvant immunotherapy; however, adjuvant immunotherapy provided similar survival benefit for patients’ irrespective comorbidity burden. Our findings suggest that patients with stage III melanoma who have a greater comorbidity burden may benefit from adjuvant immunotherapy but should not replace careful patient selection by the clinician.
AB - Background: Comorbidity burden is associated with development of cancer, stage at diagnosis, and treatment outcomes. We evaluated the association between comorbidity burden, receipt of adjuvant immunotherapy, and survival in patients with stage III melanoma. Methods: Using the National Cancer Database, we identified 16,906 patients with stage III melanoma who underwent surgery of the primary site. Outcomes included receipt of adjuvant immunotherapy and overall survival; independent variables included Charlson/Deyo comorbidity index (CDI) and receipt of adjuvant immunotherapy. Results: Patients with CDI scores of two or more averaged 30.0% and 30.9% lower adjusted odds of receiving adjuvant immunotherapy relative to patients with a CDI score of zero or one, respectively (P = 0.001 and 0.002, respectively). Longer survival was associated with lower CDI scores (all P < 0.001) and receipt of adjuvant immunotherapy (P < 0.001). Patients who received adjuvant immunotherapy averaged 16.0% lower adjusted risk of death compared to patients who did not (P < 0.001), which was constant within all CDI cohorts. Patients with a CDI score of two or more averaged 53.4% and 39.1% higher adjusted risk of death relative to patients with a CDI score of zero or one (both P < 0.001). Conclusion: Greater comorbidity burden was associated with lower receipt of adjuvant immunotherapy; however, adjuvant immunotherapy provided similar survival benefit for patients’ irrespective comorbidity burden. Our findings suggest that patients with stage III melanoma who have a greater comorbidity burden may benefit from adjuvant immunotherapy but should not replace careful patient selection by the clinician.
UR - http://www.scopus.com/inward/record.url?scp=85087150764&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85087150764&partnerID=8YFLogxK
U2 - 10.1111/ijd.15019
DO - 10.1111/ijd.15019
M3 - Article
C2 - 32592609
AN - SCOPUS:85087150764
VL - 59
SP - 1381
EP - 1390
JO - International Journal of Dermatology
JF - International Journal of Dermatology
SN - 0011-9059
IS - 11
ER -