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. 2021 Mar 22;13(6):1455.
doi: 10.3390/cancers13061455.

NCDB Analysis of Melanoma 2004-2015: Epidemiology and Outcomes by Subtype, Sociodemographic Factors Impacting Clinical Presentation, and Real-World Survival Benefit of Immunotherapy Approval

Sunny R K Singh  1 , Sindhu J Malapati  2 , Rohit Kumar  3 , Christopher Willner  1 , Ding Wang  1
Affiliations

NCDB Analysis of Melanoma 2004-2015: Epidemiology and Outcomes by Subtype, Sociodemographic Factors Impacting Clinical Presentation, and Real-World Survival Benefit of Immunotherapy Approval

Sunny R K Singh et al. Cancers (Basel). .

Abstract

Background: The incidence of invasive melanoma is rising, and approval for the first immune checkpoint inhibitor (ICI) to treat metastatic melanoma occurred in 2011. We aim to describe the epidemiology and outcomes in recent years, sociodemographic factors associated with the presence of metastasis at diagnosis, and the real-world impact of ICI approval on survival based on melanoma subtype and race. Methods: This is a retrospective analysis of the National Cancer Database (NCDB) from the years 2004-2015. The primary outcome was the overall survival of metastatic melanoma by subtype. Secondary outcomes included sociodemographic factors associated with the presence of metastasis at diagnosis and the impact of treatment facility type and ICI approval on the survival of metastatic melanoma. Results: Of the 419,773 invasive melanoma cases, 93.80% were cutaneous, and 4.92% were metastatic at presentation. The odds of presenting with metastatic disease were higher in African Americans (AA) compared to Caucasians (OR 2.37; 95% CI 2.11-2.66, p < 0.001). Treatment of metastatic melanoma at an academic/research facility was associated with lower mortality versus community cancer programs (OR 0.75, 95 % CI 0.69-0.81, p-value < 0.001). Improvement in survival of metastatic melanoma was noted for Caucasians after the introduction of ICI (adjusted HR 0.80, 95% CI 0.78-0.83, p < 0.001); however, this was not statistically significant for AA (adjusted HR 0.80, 95% CI 0.62-1.02, p-value = 0.073) or ocular cases (HR 1.03, 95% CI 0.81-1.31, p-value = 0.797). Conclusion: Real-world data suggest a 20% improvement in survival of metastatic melanoma since the introduction of ICI. The disproportionately high odds of metastatic disease at presentation in AA patients with melanoma suggest the need for a better understanding of the disease and improvement in care delivery.

Keywords: epidemiology; healthcare disparities; immune checkpoint inhibitor; immunotherapy; melanoma; real-world data.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Case schema for invasive melanoma subtypes for years 2004–2015 National Cancer Data Base (NCDB).
Figure 2
Figure 2
Burden of invasive melanoma between the years 2004 and 2015.
Figure 3
Figure 3
Kaplan–Meier analysis for (A) survival amongst all cases of invasive melanoma subtypes diagnosed between 2004 and 2015, (B) survival amongst melanoma cases with metastatic disease at presentation diagnosed between 2004 and 2015 by subtype, (C) survival pre- and postapproval of ipilimumab in 2011 amongst cases of cutaneous melanoma with metastatic disease at presentation., (D) survival pre- and postapproval of ipilimumab in 2011 amongst cases of mucosal melanoma with metastatic disease at presentation.
See this image and copyright information in PMC

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