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. 2022 Mar 31:10:806934.
doi: 10.3389/fpubh.2022.806934. eCollection 2022.

Impact of Wide Local Excision on Melanoma Patient Survival: A Population-Based Study

Alessandra Buja  1 , Massimo Rugge  2   3 , Giovanni Damiani  4   5   6 , Giuseppe De Luca  1 , Manuel Zorzi  2 , Riccardo Fusinato  7 , Chiara De Toni  8 , Antonella Vecchiato  7 , Paolo Del Fiore  7 , Francesca Falasco  7 , Romina Spina  7 , Carlo Riccardo Rossi  7   9 , Simone Mocellin  7   9
Affiliations

Impact of Wide Local Excision on Melanoma Patient Survival: A Population-Based Study

Alessandra Buja et al. Front Public Health. .

Abstract

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.

Keywords: healthcare services and policy; melanoma; quality assurance; real-word data analyses; survival analysis.

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Conflict of interest statement

This study was funded by CARIPARO, Fondazione Cassa di Risparmio di Padova e Rovigo. The foundation had no role in the study's design, the collection, analysis, or interpretation of the data, the writing of the manuscript, or the decision to submit the paper for publication. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Kaplan-Meier curves for overall and melanoma-specific survival with/without wide local excision.
Figure 2
Figure 2
Kaplan-Meier curves for melanoma-specific survival with/without wide local excision.
See this image and copyright information in PMC

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