Survival after Pulmonary Metastasectomy in Patients with Malignant Melanoma

Abstract

Background: Surgical resection is an important interdisciplinary treatment for pulmonary metastases of metastatic malignant melanoma. The purpose of this study was to determine the clinical course, outcome and prognostic factors in a subset of patients recently treated by metastasectomy. Material and Methods: Between 1995 and 2007, 30 patients (19 men, 11 women) with pulmonary metastases from malignant melanoma underwent pulmonary resection. Exclusion of primary tumor recurrence and other extrapulmonary metastases was mandatory for inclusion in the study. The median follow-up was 93.7 months. These patients' records were subsequently reviewed. Results: Cumulative 5-year survival rate after pulmonary resection was 35.1 % with a median survival of 18.3 months. Complete pulmonary resection was achieved in 27 patients who had a median survival of 20.5 months compared to 13.0 months after incomplete resection; however, completeness of resection was not a statistically prognostic factor for survival. Multivariate analysis identified gender as the only significant prognostic parameter for overall survival in the group of patients after complete resection of pulmonary metastases, with 9.4 months versus 25.0 months for the female and male group, respectively (p = 0.022). Conclusions: We conclude that pulmonary metastasectomy for metastases of malignant melanoma is a safe treatment modality which may actually be of benefit in selected patients with stage IV malignant melanoma. When pulmonary metastases of malignant melanoma are present, every attempt should be made to completely resect all clinically detected metastases.

Key words

metastases/metastasectomy - outcomes (includes mortality - morbidity) - malignant melanoma

References

• 1 Balch C M, Soong S J, Milton G W et al. A comparison of prognostic factors and surgical results in 1786 patients with localized (stage I) melanoma treated in Alabama, USA, and New South Wales, Australia.  Ann Surg. 1982;  196 (6) 677-684
• 2 Petersen R P, Hanish S I, Haney J C et al. Improved survival with pulmonary metastasectomy: an analysis of 1720 patients with pulmonary metastatic melanoma.  J Thorac Cardiovasc Surg. 2007;  133 (1) 104-110
• 3 Falkson C I, Ibrahim J, Kirkwood J M, Coates A S, Atkins M B, Blum R H. Phase III trial of dacarbazine versus dacarbazine with interferon alpha-2b versus dacarbazine with tamoxifen versus dacarbazine with interferon alpha-2b and tamoxifen in patients with metastatic malignant melanoma: an Eastern Cooperative Oncology Group study.  J Clin Oncol. 1998;  16 (5) 1743-1751
• 4 Essner R, Lee J H, Wanek L A, Itakura H, Morton D L. Contemporary surgical treatment of advanced-stage melanoma.  Arch Surg. 2004;  139 (9) 961-966
• 5 Kaplan E, Meier P. Non-parametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  53 457-481
• 6 Lee J H, Gulec S A, Kyshtoobayeva A, Sim M S, Morton D L. Biological factors, tumor growth kinetics, and survival after metastasectomy for pulmonary melanoma.  Ann Surg Oncol. 2009;  16 (10) 2834-2839
• 7 Leo F, Cagini L, Rocmans P et al. Lung metastases from melanoma: when is surgical treatment warranted?.  Br J Cancer. 2000;  83 (5) 569-572
• 8 Neuman H B, Patel A, Hanlon C, Wolchok J D, Houghton A N, Coit D G. Stage-IV melanoma and pulmonary metastases: factors predictive of survival.  Ann Surg Oncol. 2007;  14 (10) 2847-2853
• 9 Oliaro A, Filosso P L, Bruna M C, Mossetti C, Ruffini E. Pulmonary metastasectomy for melanoma.  J Thorac Oncol. 2010;  5 (6 Suppl. 2) S187-S191
• 10 Tafra L, Dale P S, Wanek L A, Ramming K P, Morton D L. Resection and adjuvant immunotherapy for melanoma metastatic to the lung and thorax.  J Thorac Cardiovasc Surg. 1995;  110 (1) 119-128
• 11 Ollila D W, Stern S L, Morton D L. Tumor doubling time: a selection factor for pulmonary resection of metastatic melanoma.  J Surg Oncol. 1998;  69 (4) 206-211
• 12 Andrews S, Robinson L, Cantor A, DeConti R C. Survival after surgical resection of isolated pulmonary metastases from malignant melanoma.  Cancer Control. 2006;  13 (3) 218-223
• 13 Kick J, Schelzig H, Heinecke A, Forster R. [Resection of lung metastases – risk or chance?].  Zentralbl Chir. 2005;  130 (6) 534-538
• 14 Harpole Jr D H, Johnson C M, Wolfe W G, George S L, Seigler H F. Analysis of 945 cases of pulmonary metastatic melanoma.  J Thorac Cardiovasc Surg. 1992;  103 (4) 743-748
• 15 Garcia-Yuste M, Cassivi S, Paleru C. Thoracic lymphatic involvement in patients having pulmonary metastasectomy: incidence and the effect on prognosis.  J Thorac Oncol. 2010;  5 (6 Suppl. 2) S166-S169
• 16 Pfannschmidt J, Klode J, Muley T, Dienemann H, Hoffmann H. Nodal involvement at the time of pulmonary metastasectomy: experiences in 245 patients.  Ann Thorac Surg. 2006;  81 (2) 448-454
• 17 Karakousis C P, Driscoll D L. Prognostic parameters in localised melanoma: gender versus anatomical location.  Eur J Cancer. 1995;  31A (3) 320-324
• 18 Miller J G, Mac Neil S. Gender and cutaneous melanoma.  Br J Dermatol. 1997;  136 (5) 657-665
• 19 Lasithiotakis K, Leiter U, Meier F et al. Age and gender are significant independent predictors of survival in primary cutaneous melanoma.  Cancer. 2008;  112 (8) 1795-1804
• 20 Perneger T V. What's wrong with Bonferroni adjustments.  BMJ. 1998;  316 (7139) 1236-1238