A recent analysis suggests that patients with advanced-stage malignant melanoma who are treated at higher-volume facilities may have improved survival outcomes and be exposed to broader treatment options compared with patients seen at lower-volume facilities. The study results were reported in the Journal of the National Comprehensive Cancer Network.

The retrospective study was based on data from the National Cancer Database for patients (N=40,676) with stage 3 or 4 cutaneous malignant melanoma who were diagnosed from 2004 through 2015. Patients were evaluated for treatments received and survival outcomes, and with regard to whether facility volume was a predictive factor for outcomes. Facility volume was stratified into 3 tiers.

Patients evaluated in this study were treated at a total of 1260 facilities. Facility volume demonstrated a significant relationship with overall survival in multivariate analyses.

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Risk of death was generally greater at lower-volume facilities. For patients with stage 3 melanoma, the hazard ratio (HR) for risk of death was 1.23 (95% CI, 1.17-1.29) at the lowest-volume facilities (T1), in comparison with the highest-volume facilities (T3). The HR for risk of death was 1.15 (95% CI, 1.09-1.20) at intermediate-volume facilities (T2) compared with T3 facilities.

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Among patients with stage 4 melanoma, the risk of death was also higher at T1 facilities (HR, 1.29 [95% CI, 1.23-1.36]) and at T2 facilities (HR, 1.16 [95% CI, 1.10-1.21]), compared with outcomes for those patients treated at T3 facilities.

Additionally, significantly higher percentages of patients with stage 4 disease were given chemotherapy and immunotherapy at T3 facilities than at T1 facilities. Chemotherapy was given to 38% of stage 4 patients at T3 facilities and 28% at T1 facilities. At T3 facilities, immunotherapy was given to 23% of stage 4 patients, while at T1 facilities it was given to 10%.

“These results underscore the need for adaptation of best practices at lower-volume facilities to improve patient outcomes,” concluded the researchers.


Tella SH, Kommalapati A, Ganti AK, Marr AS. Association between hospital volume, therapy types, and overall survival in stage III and IV cutaneous malignant melanoma. J Natl ComprCanc Netw. 2019;17(11):1334-1342.