Health Care System and Socioeconomic Factors Associated With Variance in Use of Sentinel Lymph Node Biopsy for Melanoma in the United States
Health Care System and Socioeconomic Factors Associated With Variance in Use of Sentinel Lymph Node Biopsy for Melanoma in the United States
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DOI：
10.1200/jco.2008.18.7567
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发表时间：
2009-04-10
影响因子：
45.3
通讯作者：
Lange, Julie R.
中科院分区：
文献类型：
--
作者：
Bilimoria, Karl Y.;Balch, Charles M.;Lange, Julie R.
目的指南建议对临床 IB/II 期黑色素瘤患者进行前哨淋巴结活检 (SLNB)，但不建议对临床 IA 期黑色素瘤患者进行前哨淋巴结活检 (SLNB)。本研究探讨了与 SLNB 用于临床淋巴结阴性黑色素瘤相关的因素。方法从国家癌症数据库中确定了 2004 年和 2005 年诊断为临床淋巴结阴性侵袭性黑色素瘤的患者。开发回归模型来评估临床病理学（性别、年龄、种族/族裔、合并症、T 分期）、社会经济（保险状况、教育水平、收入）和医院（医院类型、地理区域）因素与 SLNB 使用的关联。 结果总共确定了 16,598 名患者：8,073 名临床 IA 期患者和 8,525 名临床 IB/II 期黑色素瘤患者。对于临床 IB/II 期黑色素瘤，据报道 48.7% 的患者使用了 SLNB。如果年龄超过 75 岁，临床 IB/II 期黑色素瘤患者接受前哨淋巴结活检的可能性较小；患有T1b肿瘤，无肿瘤溃疡，或头/颈或躯干病变；受 Medicaid 或 Medicare 承保；或居住在东北部、南部或西部人口普查地区。据报道，13.3% 的临床 IA 期黑色素瘤患者使用了前哨淋巴结活检，并且在年龄小于 56 岁或居住在山区或太平洋人口普查地区的患者中更有可能使用前哨淋巴结活检。在国家综合癌症网络或国家癌症研究所指定医院接受治疗的患者最有可能按照国家共识指南接受 SLNB。结论 SLNB 的使用与临床病理因素相关，但也与卫生系统因素相关，包括保险类型、地理区域和医院类型。这些发现对提供者教育和卫生政策具有影响。 J 临床肿瘤杂志 27：1857-1863。 (C) 2009 年美国临床肿瘤学会
PurposeGuidelines recommend sentinel lymph node biopsy (SLNB) for patients with clinical stage IB/II melanomas, but not clinical stage IA melanoma. This study examines factors associated with SLNB use for clinically node-negative melanoma.MethodsPatients diagnosed with clinically node-negative invasive melanoma in 2004 and 2005 were identified from the National Cancer Data Base. Regression models were developed to assess the association of clinicopathologic (sex, age, race/ethnicity, comorbidities, T stage), socioeconomic (insurance status, educational level, income), and hospital (hospital type, geographic area) factors with SLNB use.ResultsA total of 16,598 patients were identified: 8,073 patients with clinical stage IA and 8,525 patients with clinical stage IB/II melanoma. For clinical stage IB/II melanoma, SLNB use was reported in 48.7% of patients. Patients with clinical stage IB/II melanoma were less likely to undergo SLNB if they were older than 75 years; had T1b tumors, no tumor ulceration, or head/neck or truncal lesions; were covered by Medicaid or Medicare; or lived in the Northeast, South, or West census regions. SLNB use was reported in 13.3% of patients with clinical stage IA melanoma and was more likely in patients who were younger than 56 years or lived in the Mountain or Pacific census regions. Patients treated at National Comprehensive Cancer Network-or National Cancer Institute-designated hospitals were most likely to undergo SLNB in adherence with national consensus guidelines.ConclusionSLNB use was associated with clinicopathologic factors but also with health system factors, including type of insurance, geographic area, and hospital type. These findings have implications for provider education and health policy. J Clin Oncol 27: 1857-1863. (C) 2009 by American Society of Clinical Oncology