Impact of time from diagnosis to surgery on overall survival

December 19, 2017

Abstract

Background

The ideal timing for melanoma treatment, predominantly surgery, remains undetermined. Patient concern for receiving immediate treatment often exceeds surgeon or hospital availability, requiring establishment of a safe window for melanoma surgery.

Objective

To assess the impact of time to definitive melanoma surgery on overall survival.

Methods

Patients with stage I to III cutaneous melanoma and with available time to definitive surgery and overall survival were identified by using the National Cancer Database (N = 153,218). The t test and chi-square test were used to compare variables. Cox regression was used for multivariate analysis.

Results

In a multivariate analysis of patients in all stages who were treated between 90 and 119 days after biopsy (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.01-1.18) and more than 119 days (HR, 1.12; 95% CI, 1.02-1.22) had a higher risk for mortality compared with those treated within 30 days of biopsy. In a subgroup analysis of stage I, higher mortality risk was found in patients treated within 30 to 59 days (HR, 1.05; 95% CI, 1.01-1.1), 60 to 89 days (HR, 1.16; 95% CI, 1.07-1.25), 90 to 119 days (HR, 1.29; 95% CI, 1.12-1.48), and more than 119 days after biopsy (HR, 1.41; 95% CI, 1.21-1.65). Surgical timing did not affect survival in stages II and III.

Limitations

Melanoma-specific survival was not available.

Conclusion

Expeditious treatment of stage I melanoma is associated with improved outcomes.

Source:

Ruzica, ZC, et al. Determination of the impact of melanoma surgical timing on survival using the National Cancer Database.  Journal of the American Academy of Dermatology.  Available online 17 October 2017. In press, Corrected Proof
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