Demographic and clinical disparities in early mortality of metastatic melanoma patients: A SEER-based analysis (2000–2021).

e21551Background: Metastatic melanoma is a devastating disease with significant disparities in survival outcomes across demographic and clinical subgroups. This study investigates early mortality (survival < 6 months) trends among metastatic melanoma patients using SEER data from 2000 to 2021. Methods: A cohort of 487 metastatic melanoma patients with survival under six months was analyzed. Kaplan-Meier survival estimates were calculated for median survival and survival probabilities at three months. Hazard ratios (HRs) and annual percent changes (APC) were calculated to assess trends, with p < 0.05 indicating statistical significance. Average annual percent changes (AAPC) were derived using Joinpoint regression. Results: The median overall survival was 2.9 months (95% CI: 2.7–3.1 months). Patients aged < 65 years demonstrated better survival outcomes (median: 3.2 months) compared to those ≥65 years (median: 2.8 months, p < 0.001). The AAPC for mortality in the ≥65 cohort was 2.1% (95% CI: 1.2%–3.0%; p = 0.001), significantly higher than 1.3% (95% CI: 0.6%–2.0%; p = 0.006) in younger patients. Gender disparities were evident, with females exhibiting a longer median survival (3.1 months, 95% CI: 2.9–3.3) than males (2.7 months, 95% CI: 2.5–2.9; p = 0.008). The AAPC was 1.8% (95% CI: 0.9%–2.7%; p = 0.002) in males and 1.2% (95% CI: 0.5%–1.9%; p = 0.015) in females. Race-based analysis highlighted significant differences. Hispanic patients had the highest three-month survival probability (30.2%, p < 0.001), followed by Non-Hispanic Whites (28.1%, p < 0.01). Non-Hispanic American Indians/Alaska Natives (NHAIAN) had the lowest survival probability (24.5%, p = 0.012). Hazard ratios for mortality were 2.31 (95% CI: 1.89–2.81, p < 0.001) in patients aged < 65 years and 3.02 (95% CI: 2.48–3.68, p < 0.001) in those ≥65 years. Males faced a 1.58-fold higher risk of death compared to females (HR: 1.58, 95% CI: 1.27–1.96, p < 0.001). Patients receiving beam radiation had modestly improved survival, with a median survival of 3.0 months (95% CI: 2.8–3.2) compared to 2.6 months (95% CI: 2.4–2.8; p = 0.012) for those without radiation. The AAPC for patients receiving radiation was 1.5% (95% CI: 0.7%–2.3%; p = 0.004). Primary tumor location significantly influenced survival. Melanoma localized to the trunk had the highest survival probability at three months (30.8%, p < 0.001) compared to melanoma of the scalp/neck, which had the lowest survival probability (25.7%, p = 0.008). Conclusions: This study highlights substantial disparities in early mortality among metastatic melanoma patients. Older age, male gender, and specific racial groups (NHAIAN) are associated with poorer outcomes, while Hispanic patients and those receiving beam radiation demonstrated modest survival advantages. Targeted interventions and improved access to care are needed to address these disparities.