Melanoma Coverage from Every Angle

Does Metastasectomy in Stage IV Melanoma Impact Overall Survival?

By: Melissa E. Fryman, MS
Posted: Tuesday, July 16, 2019

According to W. Clark Lambert, MD, PhD, of Rutgers University, New Jersey, and colleagues, nonprimary-site surgery seems to prolong overall survival in patients with stage IV melanoma. Moreover, older patients with private insurance, those treated at a private institution, those with skin or brain metastases, or those who received previous radiation therapy were more likely to undergo metastasectomy. These study findings were published in the Journal of the European Academy of Dermatology and Venereology.  

“Metastasectomy for stage IV melanoma is independently associated with improved overall survival in metastatic cases involving the skin, lung, and visceral organs,” the authors concluded.

In this study, a total of 14,034 cases culled from the National Cancer Database, involving patients with stage IV melanoma, were included in analysis. Of these patients, 30% (4,214 patients) underwent metastasectomy.

The median and 5-year rates of overall survival were higher in patients who underwent metastasectomy than in those who did not receive nonprimary surgery (15.7 months and 13.2% vs. 7.1 months and 5.6%, respectively, P < .001). For patients with cutaneous metastasis, the median survival was 46.4 months versus 15.3 months for patients with other metastases (P < .001). The rates of cutaneous metastasectomy were higher than rates of noncutaneous metastasectomy (34.6% vs. 28.4%, P < .001). Of the patients who underwent metastasectomy, 20.3% had primary-site surgery, 33.6% had radiation therapy, 26.5% had chemotherapy, and 31.5% had immunotherapy.

Lastly, after the investigators controlled for covariates, Cox proportional hazard regression modeling revealed longer survival for all patients who had undergone metastasectomy. Individual analyses for patients who had undergone cutaneous, lung, or visceral metastasectomy also showed longer survival (P < .001 for all).

Disclosure: The study authors reported no conflicts of interest.

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