Medical Immunosuppression and Outcomes in Cutaneous Melanoma: A Population-Based Cohort Study
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ORIGINAL ARTICLE – MELANOMA
Medical Immunosuppression and Outcomes in Cutaneous Melanoma: A Population-Based Cohort Study Jessica Bogach, MD, MSc1 , Frances C. Wright, MD, MEd1,2, Janice Austin, MD3, Stephanie Y. Cheng, MSc4, Christina Diong, MSc4, Rinku Sutradhar, PhD4,5, Nancy N. Baxter, MD, PhD6,7,8,9, and Nicole J. Look Hong, MD, MSc1,2 Department of Surgery, University of Toronto, Toronto, ON, Canada; 2Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 3Department of Surgery, Joseph Brant Hospital, McMaster University, Hamilton, ON, Canada; 4ICES, Toronto, ON, Canada; 5Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; 6 Cancer Research Program, ICES, Toronto, ON, Canada; 7Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada; 8Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada; 9Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia 1
ABSTRACT Background. Melanoma and the immune system are intimately related. However, the association of immunosuppressive medications (ISMs) with survival in melanoma is not well understood. The study evaluated this at a population level. Methods. A cohort of patients with a diagnosis of invasive cutaneous melanoma (2007–2015) was identified from the Ontario Cancer Registry and linked to identify demographics, stage at diagnosis, prescription of immunosuppressive medications (both before and after diagnosis), and outcomes. The demographics of patients with and without prescriptions for ISM were compared. Patients eligible for Ontario’s Drug Benefit Plan were included to ensure accurate prescription data. The primary outcome was overall survival. Cox Proportional Hazards
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09224-9) contains supplementary material, which is available to authorized users. This paper was accepted as a poster to the annual Society of Surgical Oncology meeting, and was virtually presented in August 2020. Ó Society of Surgical Oncology 2020 First Received: 15 July 2020 Accepted: 22 September 2020 J. Bogach, MD, MSc e-mail: [email protected]
Regression models identified factors associated with mortality, including use of ISM as a time-varying covariate. Results. Of the 4954 patients with a diagnosis of cutaneous melanoma, 1601 had a prescription for ISM. The median age of the patients was 74 years. Overall, 58.4% of the patients were men (60.5% of those without ISM and 54% of those using ISM; p \ 0.001). The use of oral immunosuppression was associated with an increased hazard of death (hazard ratio, 5.84; 95% confidence interval, 5.11–6.67; p \ 0.0001) when control was used for age, disease stage at diagnosis, anatomic site, comorbidity, and treatment. Other factors associated with death were increasing age, male sex, increased disease stage, truncal location of primary melanoma, and inadequate treatment. In se
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