Metastasectomy for metastatic melanoma in the era of effective systemic therapy

Issac R Schwantes; Thomas Sutton; Shay Behrens; Graham Fowler; Gang Han; John T Vetto; Dale Han

doi:10.1016/j.amjsurg.2023.04.020

Metastasectomy for metastatic melanoma in the era of effective systemic therapy

Am J Surg. 2024 May:231:65-69. doi: 10.1016/j.amjsurg.2023.04.020. Epub 2023 May 23.

Authors

Issac R Schwantes¹, Thomas Sutton¹, Shay Behrens¹, Graham Fowler¹, Gang Han², John T Vetto³, Dale Han⁴

Affiliations

¹ Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
² Texas A&M University, Department of Epidemiology and Biostatistics. School of Public Health, College Station, TX, USA.
³ Department of Surgery, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University, Division of Surgical Oncology-Knight Cancer Institute, Portland, OR, USA. Electronic address: vettoj@ohsu.edu.
⁴ Department of Surgery, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University, Division of Surgical Oncology-Knight Cancer Institute, Portland, OR, USA.

PMID: 37308347
DOI: 10.1016/j.amjsurg.2023.04.020

Abstract

Introduction: Effective systemic therapy (EST) in patients with metachronous metastatic melanoma (MMM) improves survival and alters surgical decision-making. Surgical metastasectomy is another treatment option, however, it is unclear if metastasectomy confers survival benefit. This study seeks to identify any survival benefit associated with surgical management of MMM.

Methods: Patients with MMM from 2009 to 2021 were grouped by receipt of metastasectomy and treatment era (pre-versus post-EST). Overall survival (OS) was calculated from date of metastasis and evaluated with Kaplan-Meier analysis.

Results: Our dataset identified 226 patients with MMM; 32% were diagnosed pre-EST. On Kaplan-Meier analysis, OS was improved for patients undergoing treatment post-versus pre-EST (p < 0.001). In the post-EST era, metastasectomy was associated with an increase in OS compared to no resection (p = 0.022).

Conclusions: In the post-EST group, EST paired with metastasectomy was associated with improved OS compared to the pre-EST group, suggesting persistent evidence of a survival benefit from metastasectomy.

Keywords: Melanoma; Metastasectomy; Metastases; Systemic therapy.

MeSH terms

Humans
Kaplan-Meier Estimate
Melanoma* / pathology
Metastasectomy*
Prognosis
Retrospective Studies
Survival Rate