Association of Surgical Treatment, Systemic Therapy, and Survival in Patients With Abdominal Visceral Melanoma Metastases, 1965-2014: Relevance of Surgical Cure in the Era of Modern Systemic Therapy | Gastroenterology | JAMA Surgery | JAMA Network
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Original Investigation
April 5, 2017

Association of Surgical Treatment, Systemic Therapy, and Survival in Patients With Abdominal Visceral Melanoma Metastases, 1965-2014: Relevance of Surgical Cure in the Era of Modern Systemic Therapy

Author Affiliations
  • 1Division of Surgical Oncology, Department of Surgery, Hofstra Northwell School of Medicine, Uniondale, New York
  • 2Valley Health Cancer Center, Winchester Medical Center, Winchester, Virginia
  • 3Roper St Francis Physician Partners, Charleston, South Carolina
  • 4David Geffen School of Medicine at University of California, Los Angeles
  • 5University of Queensland School of Medicine, Ochsner Clinical School, Brisbane, Australia
  • 6John Wayne Cancer Institute at Providence St Johns Health Center, Santa Monica, California
  • 7California Oncology Research Institute, Los Angeles, California
JAMA Surg. 2017;152(7):672-678. doi:10.1001/jamasurg.2017.0459
Key Points

Question  What is the role of surgical resection of abdominal visceral melanoma metastases in the era of modern systemic therapy?

Findings  In this review of 1623 patients with abdominal visceral melanoma metastases, median overall survival was superior in surgical (18.0 months) vs nonsurgical (7.0 months) patients. The most favorable 1-year and 2-year overall survival was seen after surgery for gastrointestinal tract and liver metastases, respectively, and the era of systemic treatment did not have a significant effect.

Meaning  Surgical resection of abdominal visceral melanoma metastases continues to afford patients durable long-term survival irrespective of advances in systemic treatment.

Abstract

Importance  Systemic therapy for metastatic melanoma has evolved rapidly during the last decade, and patient treatment has become more complex.

Objective  To evaluate the survival benefit achieved through surgical resection of melanoma metastatic to the abdominal viscera in patients treated in the modern treatment environment.

Design, Setting, and Participants  This retrospective review of the institutional melanoma database from the John Wayne Cancer Institute at Providence St Johns Health Center, a tertiary-level melanoma referral center, included 1623 patients with melanoma diagnosed as having potentially resectable abdominal metastases before (1969-2003) and after (2004-2014) advances in systemic therapy.

Main Outcomes and Measures  Overall survival (OS).

Results  Of the 1623 patients identified in the database with abdominal melanoma metastases, 1097 were men (67.6%), and the mean (SD) age was 54.6 (14.6) years. Of the patients with metastatic melanoma, 1623 (320 [19.7%] in the 2004-2014 period) had abdominal metastases, including 336 (20.7%) with metastases in the gastrointestinal tract, 697 (42.9%) in the liver, 138 (8.5%) in the adrenal glands, 38 (2.3%) in the pancreas, 109 (6.7%) in the spleen, and 305 (18.8%) with multiple sites. Median OS was superior in surgical (n = 392; 18.0 months) vs nonsurgical (n = 1231; 7.0 months) patients (P < .001). The most favorable 1-year and 2-year OS was seen after surgery for gastrointestinal tract (52% and 41%) and liver (51% and 38%) metastases, respectively. Multivariable analysis found increasing age (hazard ratio [HR], 1.01; 95% CI, 1.00-1.01; P = .02) and the presence of ulceration (HR, 1.21; 95% CI, 1.01-1.45; P = .04) were associated with a worse OS. Alternatively, treatment with metastasectomy (HR, 0.59; 95% CI, 0.46-0.74; P < .001) and metastases involving the gastrointestinal tract (HR, 0.65; 95% CI, 0.48-0.87; P = .004) were associated with a better OS. The systemic treatment era did not significantly affect outcomes (HR, 0.82; 95% CI, 0.67-1.02; P = .15). Overall, patients with gastrointestinal tract metastases undergoing complete, curative resection derived the greatest benefit, with a median OS of 64 months.

Conclusions and Relevance  To our knowledge, this series is the largest single-institution experience with abdominal melanoma metastases, demonstrating that surgical resection remains an important treatment consideration even in the systemic treatment era.

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