The Relationship Between Hospital Immunotherapy Volume and Treatment and Survival of Advanced Cutaneous Melanoma

Immunotherapy (IMT) has improved survival for patients with advanced cutaneous melanoma, yet disparities in IMT receipt persist. Additionally, hospital case volume is associated with outcomes in melanoma; however, the relationship between hospital IMT volume and treatment patterns and survival across racial groups remains unknown. We examined associations between hospital-level IMT volume and receipt of IMT/survival among patients with advanced cutaneous melanoma by race.

Adults with stage III/IV cutaneous melanoma diagnosed between 2012 and 2020 were identified in the National Cancer Database. Hospitals were ranked by IMT case volume for nonmelanoma cancers, with the top decile classified as high-volume IMT hospitals. We examined the receipt of IMT and overall survival for melanoma by race.

Among 47,783 patients, 30.1; percentage received IMT. At high-volume IMT hospitals, there was no significant difference in IMT receipt between non-White and White patients with melanoma (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.93-1.26). At low-volume IMT hospitals, non-White patients had higher odds of receiving IMT than White patients with melanoma (OR 1.22, 95% CI 1.03-1.44). Both White and non-White patients at low-volume IMT hospitals had lower odds of receiving IMT for melanoma than their counterparts at high-volume IMT hospitals (White: OR 0.36, 95% CI 0.30-0.45; non-White: OR 0.41, 95% CI 0.31-0.55). Treatment at high-volume IMT hospitals was associated with improved survival across all patients (hazard ratio = 0.83 [95% CI 0.81-0.86]).

Treatment at high-volume IMT hospitals is associated with greater IMT utilization and higher survival for patients with advanced cutaneous melanoma, with fewer observed racial disparities in treatment/outcomes.