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Survival for Patients With Invasive Cutaneous Melanoma Among Ethnic Groups: The Effects of Socioeconomic Status and Treatment

Jason A. Zell, Pelin Cinar, Mehrdad Mobasher, Argyrios Ziogas, Frank L. Meyskens, Jr, Hoda Anton-Culver

From the Division of Hematology/Oncology, Department of Internal Medicine, Chao Family Comprehensive Cancer Center; the Department of Epidemiology, School of Medicine; and the Genetic Epidemiology Research Institute, University of California, Irvine; and the Divisions of Hematology and Oncology, Stanford University, Palo Alto, CA

Corresponding author: Jason A. Zell, DO, MPH, Department of Epidemiology, University of California, Irvine, 224 Irvine Hall, Irvine, CA 92697; e-mail: jzell{at}uci.edu

Purpose Although uncommon, melanoma is associated with poor survival characteristics among African Americans and Hispanics compared with non-Hispanic whites (NHWs). Low socioeconomic status (SES) is also associated with poor survival among patients with melanoma, but it is not known whether this is because of SES itself or because of treatment disparities. We set out to determine this by using the large, population-based California Cancer Registry (CCR) database as a model.

Patients and Methods We conducted a case-only analysis of CCR data (1993 to 2003), including a descriptive analysis of relevant clinical variables and SES. The SES variable used has been derived from principle component analysis of census block-level CCR data that was linked to census data to address seven indicators of SES. Univariate analyses of overall survival (OS) were conducted using the Kaplan-Meier method. Multivariate survival analyses were performed using Cox proportional hazard ratios (HRs).

Results A total of 39,049 incident patient cases of cutaneous melanoma, including 36,694 in NHWs; 127 in African Americans; 1,996 in Hispanics; and 262 in Asian-Americans, were analyzed. Higher SES was associated with an early stage at presentation (P < .0001), with treatment with surgery (P = .0005), and with prolonged survival (P < .0001). After adjustments for age, sex, histology, American Joint Committee on Cancer stage, anatomic site, treatment, and SES, a statistically significant increased risk of death was observed for African Americans compared with NHWs (HR, 1.60; 95% CI, 1.17 to 2.18); no survival differences were noted for Asians or Hispanics compared with NHWs in the adjusted analysis.

Conclusion Low SES independently predicts poor outcome among patients with cutaneous melanoma. However, the poor OS observed for African American patients with melanoma is not explained by differences in treatment or SES.

Cancer incidence data used in this study under subcontract No. 050N-8707-S1527 with the Public Health Institute, State of California, was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Sections 103875 and 103885; the National Cancer Institute Surveillance, Epidemiology and End Results Program; and the Centers for Disease Control and Prevention National Program of Cancer Registries.

Presented in part at the 42nd Annual Meeting of the American Society of Clinical Oncology, Atlanta, GA, June 2-6, 2006.

The ideas and opinions expressed herein are those of the authors, and endorsement by the State of California, Department of Health Services, the National Cancer Institute, the Centers for Disease Control and Prevention, and/or the Genetic Epidemiology Research Institute of the University of California, Irvine is not intended, nor should it be inferred.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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