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Treatment outcomes in pediatric melanoma-Are there benefits to specialized care?

Authors:
Benjamin Freemyer Emma Hamilton Carla L Warneke Ali M Ali Cynthia Herzog Andrea Hayes-Jordan Mary Austin

J Pediatr Surg 2016 Dec 17;51(12):2063-2067. Epub 2016 Sep 17.

Department of Pediatric Surgery, The McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, Suite 5.258, Houston, TX 77030; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX 77030. Electronic address:

Purpose: The purpose of this study was to evaluate the impact of hospital specialization on survival in pediatric melanoma.

Methods: We reviewed all patients under 18years old with cutaneous melanoma evaluated at MD Anderson Cancer Center, a National Cancer Institute (NCI)-designated center, from 2000 to 2014. We compared overall survival (OS) and disease-free survival (DFS) between patients who underwent all treatments at MDACC (Group A, n=146) and those who underwent initial surgical treatment at a non-NCI center (Group B, n=58). Kaplan-Meier survival curves were compared using the log-rank test.

Results: Group A patients had significantly better OS and DFS (both p<0.001). Five-year OS was 97% (95% CI 92%-99%) in Group A versus 88% (95% CI 74%-94%) in Group B. Group survival differences were most notable in Stage 3 and 4 patients. Group A patients presenting with stage III or IV disease had a 5-year OS rate of 91.2% (95% CI 75.1%-97.1%) compared to 80.8% (95% CI 59.8%-91.5%) in Group B. The DFS rate was 94.4% (95% CI 88.5%-97.3%) in Group A versus 77.2% (95% CI 62.5%-86.7%) in Group B.

Conclusion: Surgical treatment at a comprehensive cancer center may improve outcomes for pediatric melanoma especially for patients presenting with later stage disease.

Level Of Evidence: Case-control study: Level III.

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http://dx.doi.org/10.1016/j.jpedsurg.2016.09.039DOI Listing
December 2016

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