Abstract：
BACKGROUND: Minority-serving hospitals (MSHs) have been associated with lower guideline adherence and worse outcomes for various cancers. However, the relationship among MSH status, concordance with sentinel lymph node biopsy (SLNB) guidelines, and overall survival (OS) for patients with cutaneous melanoma is not well studied.
METHODS: The National Cancer Database was queried for patients diagnosed with T1a*, T2, and T3 melanoma between 2012 and 2017. MSHs were defined as the top decile of institutions ranked by the proportion of minorities treated for melanoma. Based on National Comprehensive Cancer Network guidelines, guideline-concordant care (GCC) was defined as not undergoing SLNB if thickness was < 0.76 mm without ulceration, mitosis ≥ 1/mm2, or lymphovascular invasion (T1a*), and performing SLNB for patients with intermediate thickness melanomas between 1.0 and 4.0 mm (T2/T3). Multivariable logistic regressions examined associations with GCC. The Kaplan-Meier method and log-rank tests were used to evaluate OS between MSH and non-MSH facilities.
RESULTS: Overall, 5.9% (N = 2182/36,934) of the overall cohort and 37.8% of minorities (n = 199/527) were managed at MSHs. GCC rates were 89.5% (n = 33,065/36,934) in the overall cohort and 85.4% (n = 450/527) in the minority subgroup. Patients in the overall cohort (odds ratio [OR] 0.85; p = 0.02) and the minority subgroup (OR 0.55; p = 0.02) were less likely to obtain GCC if they received their care at MSHs compared with non-MSHs. Minority patients receiving care at MSHs had a decreased survival compared with those treated at non-MSHs (p = 0.002).
CONCLUSIONS: Adherence to SLNB guidelines for melanoma was lower at MSHs. Continued focus is needed on equity in melanoma care for minority patients in the United States.
METHODS: The National Cancer Database was queried for patients diagnosed with T1a*, T2, and T3 melanoma between 2012 and 2017. MSHs were defined as the top decile of institutions ranked by the proportion of minorities treated for melanoma. Based on National Comprehensive Cancer Network guidelines, guideline-concordant care (GCC) was defined as not undergoing SLNB if thickness was < 0.76 mm without ulceration, mitosis ≥ 1/mm2, or lymphovascular invasion (T1a*), and performing SLNB for patients with intermediate thickness melanomas between 1.0 and 4.0 mm (T2/T3). Multivariable logistic regressions examined associations with GCC. The Kaplan-Meier method and log-rank tests were used to evaluate OS between MSH and non-MSH facilities.
RESULTS: Overall, 5.9% (N = 2182/36,934) of the overall cohort and 37.8% of minorities (n = 199/527) were managed at MSHs. GCC rates were 89.5% (n = 33,065/36,934) in the overall cohort and 85.4% (n = 450/527) in the minority subgroup. Patients in the overall cohort (odds ratio [OR] 0.85; p = 0.02) and the minority subgroup (OR 0.55; p = 0.02) were less likely to obtain GCC if they received their care at MSHs compared with non-MSHs. Minority patients receiving care at MSHs had a decreased survival compared with those treated at non-MSHs (p = 0.002).
CONCLUSIONS: Adherence to SLNB guidelines for melanoma was lower at MSHs. Continued focus is needed on equity in melanoma care for minority patients in the United States.
摘要：
背景：少数族裔服务医院（MSH）与各种癌症的指南依从性较低和预后较差有关。然而,MSH状态之间的关系，符合前哨淋巴结活检（SLNB）指南，皮肤黑色素瘤患者的总生存期（OS）尚未得到很好的研究。
方法：国家癌症数据库查询了诊断为T1a*的患者，2012年至2017年之间的T2和T3黑色素瘤。MSH被定义为按接受黑色素瘤治疗的少数民族比例排名最高的机构。根据国家综合癌症网络指南，指南一致护理（GCC）定义为如果厚度<0.76mm无溃疡，则不进行SLNB，有丝分裂≥1/mm2，或淋巴管浸润（T1a*），并对1.0至4.0mm（T2/T3）的中等厚度黑色素瘤患者进行SLNB。多变量逻辑回归分析了与GCC的关联。Kaplan-Meier方法和对数秩检验用于评估MSH和非MSH设施之间的OS。
结果：总体而言，整体队列中的5.9％（N=2182/36,934）和37.8％的少数民族（n=199/527）在MSH中得到了管理。总体队列中GCC率为89.5%(n=33,065/36,934)，少数亚组为85.4%(n=450/527)。总体队列（比值比[OR]0.85;p=0.02）和少数亚组（OR0.55;p=0.02）中的患者如果在MSH与非MSH接受治疗，则获得GCC的可能性较小。与非MSH相比，接受MSH治疗的少数患者的生存率降低（p=0.002）。
结论：MSHs对黑色素瘤SLNB指南的依从性较低。在美国，需要继续关注黑色素瘤少数患者的治疗公平性。
方法：国家癌症数据库查询了诊断为T1a*的患者，2012年至2017年之间的T2和T3黑色素瘤。MSH被定义为按接受黑色素瘤治疗的少数民族比例排名最高的机构。根据国家综合癌症网络指南，指南一致护理（GCC）定义为如果厚度<0.76mm无溃疡，则不进行SLNB，有丝分裂≥1/mm2，或淋巴管浸润（T1a*），并对1.0至4.0mm（T2/T3）的中等厚度黑色素瘤患者进行SLNB。多变量逻辑回归分析了与GCC的关联。Kaplan-Meier方法和对数秩检验用于评估MSH和非MSH设施之间的OS。
结果：总体而言，整体队列中的5.9％（N=2182/36,934）和37.8％的少数民族（n=199/527）在MSH中得到了管理。总体队列中GCC率为89.5%(n=33,065/36,934)，少数亚组为85.4%(n=450/527)。总体队列（比值比[OR]0.85;p=0.02）和少数亚组（OR0.55;p=0.02）中的患者如果在MSH与非MSH接受治疗，则获得GCC的可能性较小。与非MSH相比，接受MSH治疗的少数患者的生存率降低（p=0.002）。
结论：MSHs对黑色素瘤SLNB指南的依从性较低。在美国，需要继续关注黑色素瘤少数患者的治疗公平性。
