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Impact of Wide Local Excision on Melanoma Patient Survival: A Population-Based Study
INTRODUCTION: Promoting standardization and quality assurance (QA) in oncology on the strength of real-world data is essential to ensure better patient outcomes. Wide excision after primary tumor biopsy is a fundamental step in the therapeutic pathway for cutaneous malignant melanoma (CMM). The aim...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9008755/ https://www.ncbi.nlm.nih.gov/pubmed/35433570 http://dx.doi.org/10.3389/fpubh.2022.806934 |
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author | Buja, Alessandra Rugge, Massimo Damiani, Giovanni De Luca, Giuseppe Zorzi, Manuel Fusinato, Riccardo De Toni, Chiara Vecchiato, Antonella Del Fiore, Paolo Falasco, Francesca Spina, Romina Rossi, Carlo Riccardo Mocellin, Simone |
author_facet | Buja, Alessandra Rugge, Massimo Damiani, Giovanni De Luca, Giuseppe Zorzi, Manuel Fusinato, Riccardo De Toni, Chiara Vecchiato, Antonella Del Fiore, Paolo Falasco, Francesca Spina, Romina Rossi, Carlo Riccardo Mocellin, Simone |
author_sort | Buja, Alessandra |
collection | PubMed |
description | INTRODUCTION: Promoting standardization and quality assurance (QA) in oncology on the strength of real-world data is essential to ensure better patient outcomes. Wide excision after primary tumor biopsy is a fundamental step in the therapeutic pathway for cutaneous malignant melanoma (CMM). The aim of this population-based cohort study is to assess adherence to wide local excision in a cohort of patients diagnosed with CMM and the impact of this recommended procedure on overall and disease-specific survival. MATERIALS AND METHODS: This retrospective cohort study concerns CMM patients diagnosed in the Veneto region (north-east Italy) in 2017, included in the high-resolution Veneto Cancer Registry, and followed up through linkage with the regional mortality registry up until February 29th, 2020. Using population-level real-world data, linking patient-level cancer registry data with administrative records of clinical procedures may shed light on the real-world treatment of CMM patients in accordance with current guidelines. After excluding TNM stage IV patients, a Cox regression analysis was performed to test whether the completion of a wide local excision was associated with a difference in melanoma-specific and overall survival, after adjusting for other covariates. RESULTS: No wide excision after the initial biopsy was performed in 9.7% of cases in our cohort of 1,305 patients. After adjusting for other clinical prognostic characteristics, Cox regression revealed that failure to perform a wide local excision raised the hazard ratio of death in terms of overall survival (HR = 4.80, 95% CI: 2.05–11.22, p < 0.001) and melanoma-specific survival (HR = 2.84, 95% CI: 1.04–7.76, p = 0.042). CONCLUSION: By combining clinical and administrative data, this study on real-world clinical practice showed that almost one in ten CMM patients did not undergo wide local excision surgery. Monitoring how diagnostic-therapeutic protocols are actually implemented in the real world may contribute significantly to promoting quality improvements in the management of oncological patients. |
format | Online Article Text |
id | pubmed-9008755 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-90087552022-04-15 Impact of Wide Local Excision on Melanoma Patient Survival: A Population-Based Study Buja, Alessandra Rugge, Massimo Damiani, Giovanni De Luca, Giuseppe Zorzi, Manuel Fusinato, Riccardo De Toni, Chiara Vecchiato, Antonella Del Fiore, Paolo Falasco, Francesca Spina, Romina Rossi, Carlo Riccardo Mocellin, Simone Front Public Health Public Health INTRODUCTION: Promoting standardization and quality assurance (QA) in oncology on the strength of real-world data is essential to ensure better patient outcomes. Wide excision after primary tumor biopsy is a fundamental step in the therapeutic pathway for cutaneous malignant melanoma (CMM). The aim of this population-based cohort study is to assess adherence to wide local excision in a cohort of patients diagnosed with CMM and the impact of this recommended procedure on overall and disease-specific survival. MATERIALS AND METHODS: This retrospective cohort study concerns CMM patients diagnosed in the Veneto region (north-east Italy) in 2017, included in the high-resolution Veneto Cancer Registry, and followed up through linkage with the regional mortality registry up until February 29th, 2020. Using population-level real-world data, linking patient-level cancer registry data with administrative records of clinical procedures may shed light on the real-world treatment of CMM patients in accordance with current guidelines. After excluding TNM stage IV patients, a Cox regression analysis was performed to test whether the completion of a wide local excision was associated with a difference in melanoma-specific and overall survival, after adjusting for other covariates. RESULTS: No wide excision after the initial biopsy was performed in 9.7% of cases in our cohort of 1,305 patients. After adjusting for other clinical prognostic characteristics, Cox regression revealed that failure to perform a wide local excision raised the hazard ratio of death in terms of overall survival (HR = 4.80, 95% CI: 2.05–11.22, p < 0.001) and melanoma-specific survival (HR = 2.84, 95% CI: 1.04–7.76, p = 0.042). CONCLUSION: By combining clinical and administrative data, this study on real-world clinical practice showed that almost one in ten CMM patients did not undergo wide local excision surgery. Monitoring how diagnostic-therapeutic protocols are actually implemented in the real world may contribute significantly to promoting quality improvements in the management of oncological patients. Frontiers Media S.A. 2022-03-31 /pmc/articles/PMC9008755/ /pubmed/35433570 http://dx.doi.org/10.3389/fpubh.2022.806934 Text en Copyright © 2022 Buja, Rugge, Damiani, De Luca, Zorzi, Fusinato, De Toni, Vecchiato, Del Fiore, Falasco, Spina, Rossi and Mocellin. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Public Health Buja, Alessandra Rugge, Massimo Damiani, Giovanni De Luca, Giuseppe Zorzi, Manuel Fusinato, Riccardo De Toni, Chiara Vecchiato, Antonella Del Fiore, Paolo Falasco, Francesca Spina, Romina Rossi, Carlo Riccardo Mocellin, Simone Impact of Wide Local Excision on Melanoma Patient Survival: A Population-Based Study |
title | Impact of Wide Local Excision on Melanoma Patient Survival: A Population-Based Study |
title_full | Impact of Wide Local Excision on Melanoma Patient Survival: A Population-Based Study |
title_fullStr | Impact of Wide Local Excision on Melanoma Patient Survival: A Population-Based Study |
title_full_unstemmed | Impact of Wide Local Excision on Melanoma Patient Survival: A Population-Based Study |
title_short | Impact of Wide Local Excision on Melanoma Patient Survival: A Population-Based Study |
title_sort | impact of wide local excision on melanoma patient survival: a population-based study |
topic | Public Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9008755/ https://www.ncbi.nlm.nih.gov/pubmed/35433570 http://dx.doi.org/10.3389/fpubh.2022.806934 |
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