Biological factors, tumor growth kinetics, and survival after metastasectomy for pulmonary melanoma

Ann Surg Oncol. 2009 Oct;16(10):2834-9. doi: 10.1245/s10434-009-0583-5. Epub 2009 Jul 15.


Introduction: Approximately 23% of melanoma patients will eventually develop pulmonary metastases and have a median survival of only about 7-11 months. Because pulmonary metastasectomy can improve this statistic, we investigated clinicopathologic features and biological correlates that might be used to identify surgical candidates.

Methods: Archived operative specimens and clinical records were retrieved for 20 melanoma patients who underwent resection of isolated pulmonary metastases at the John Wayne Cancer Institute, Saint John's Health Center. Five-year postmetastasectomy survival (PMS) rate was correlated with age, number of pulmonary metastases, tumor doubling time (TDT), tumor necrosis, and immunohistochemical expressions of four biological markers: Ki-67, glucose transporter-1 (Glut-1), caspase-3, and CD31.

Results: Median TDT was 61 days. On multivariate analysis, TDT (P = 0.008), Glut-1 intensity (P = 0.04), and CD31 expression (P = 0.004) were the significant predictors of PMS. Age, number of pulmonary metastases, tumor necrosis, and expression of Ki-67 or caspase-3 did not significantly impact survival. Median TDT was 56 days with Glut-1 expression versus 165 days without Glut-1 expression (P = 0.002), and Glut-1 staining intensity independently affected TDT (P = 0.012).

Conclusions: Surgical resection may be preferable to toxic systemic therapies in melanoma patients whose isolated pulmonary metastases have a long TDT (> or = 61 days) and no biopsy evidence of Glut-1 expression.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Apoptosis
  • Biomarkers, Tumor / analysis*
  • Caspase 3 / analysis
  • Cell Proliferation
  • Excitatory Amino Acid Transporter 2 / analysis
  • Female
  • Follow-Up Studies
  • Humans
  • Immunoenzyme Techniques
  • Ki-67 Antigen / analysis
  • Lung Neoplasms / chemistry*
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / secondary
  • Male
  • Melanoma / chemistry*
  • Melanoma / mortality*
  • Melanoma / secondary
  • Middle Aged
  • Necrosis
  • Neoplasm Staging
  • Platelet Endothelial Cell Adhesion Molecule-1 / analysis
  • Prognosis
  • Risk Factors
  • Survival Rate
  • Treatment Outcome


  • Biomarkers, Tumor
  • Excitatory Amino Acid Transporter 2
  • Ki-67 Antigen
  • Platelet Endothelial Cell Adhesion Molecule-1
  • Caspase 3