Stage-IV Melanoma and Pulmonary Metastases: Factors Predictive of Survival

Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H1221, New York, New York 10021, USA.
Annals of Surgical Oncology (Impact Factor: 3.93). 10/2007; 14(10):2847-53. DOI: 10.1245/s10434-007-9448-y
Source: PubMed


We reviewed a contemporary, single-institution experience to evaluate the natural history of stage-IV melanoma metastatic to the lung and identify factors predictive of survival.
A search of our prospective database was performed to identify patients with stage-IV melanoma and pulmonary metastases as the initial disease site; only patients seen at our institution prior to developing stage-IV disease and in whom treatment response was available were included. Patients' demographic, clinical, and treatment variables were recorded. Cox regression was used to identify factors independently predictive of survival.
The study cohort was comprised of 122 patients. Median survival was 14 months (5-year survival of 8%). Clinical factors at time of diagnosis of stage IV independently predictive of survival were a solitary pulmonary metastasis (HR 2.7, CI 1.6-4.4, P<0.0005) and absence of extra-pulmonary disease (HR 1.9, CI 1.2-3.1, P = 0.01). Among treatment factors, only metastasectomy was independently predictive of survival (HR 0.42, CI 0.21-0.87, P = 0.02). Of the patients, 26 (21%) underwent metastasectomy, with a median survival of 40 months compared with 13 months in patients not selected for surgical treatment. Of these 26, 23 (88%) experienced recurrence at a median of 5 months after the procedure. No survival difference was seen between responders and non-responders to systemic therapy (P = 0.55).
In stage-IV melanoma with pulmonary metastases, a solitary metastasis and absence of extra-pulmonary disease are predictive of survival. While these factors are often present in patients selected for pulmonary metastasectomy, this independently predicts survival. However, response to systemic therapy does not correlate with a survival difference.

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    • "1). Hinterfragen muss man die kurative Intention der Metastasektomie, da sich die Rezidivraten nach der Operation zwischen 42% und 88% bewegen (Tab. 1) [11] [13] [14] [16] [17] [19] [23] [24] [25] "

    No preview · Article · Jan 2014 · Atemwegs- und Lungenkrankheiten
    • "Several research groups have reported favourable survival for patients after complete metastasectomy of distant metastases (Ollila et al, 1996; Leo et al, 2000; Meyer et al, 2000; Wood et al, 2001; Essner et al, 2004; Neuman et al, 2007; Wasif et al, 2011) with 5-year survival rates up to 41% (Ollila et al, 1996). Nevertheless, the impact of this procedure is still unclear, because a randomised trial has never been published and the majority of analyses comprised selected patient subgroups only. "
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    ABSTRACT: Established prognostic factors are of limited value to predict long-term survival and benefit from metastasectomy in advanced melanoma. This study aimed to identify prognostic factors in patients with distant metastasis. We analysed overall survival of 855 institutional melanoma patients with distant metastasis by bivariate Kaplan-Meier survival probabilities and multivariate Cox hazard regression analysis. Serum lactate dehydrogenases (LDH), S100B, the interval between initial diagnosis and occurrence of distant metastasis, the site of distant metastases, and the number of involved distant sites were significant independent prognostic factors in both bivariate and multivariate analyses. Visceral metastases other than lung (hazard ratio (HR) 1.8), elevated S100B (HR 1.7) and elevated LDH (HR 1.6) had the highest negative impact on survival. Complete metastasectomy was likewise an independent prognostic factor in multivariate analysis. This treatment was associated with favourable survival for patients with normal LDH and S100B values (5-year survival, 37.2%). The serum markers LDH and S100B were both found to be prognostic factors in melanoma patients with distant metastasis. Furthermore, complete metastasectomy had an independent favourable prognostic impact in particular for the patient subgroup with normal LDH and S100B values.
    No preview · Article · Jul 2012 · British Journal of Cancer
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    ABSTRACT: BACKGROUND: The major obstacle in curing cancer is the limited ability to prevent and treat metastatic disease. Pulmonary metastasectomy is now a standard treatment option in carefully selected cases. With the lung being frequently the only site of metastasis, a complete resection of all tumor masses poses a potentially curative treatment option. METHODS: This review article gives an outline of the basics of pulmonary metastasectomy and reviews the latest research in this field. RESULTS AND CONCLUSIONS: Technical advances in thoracic surgery during the past decades made pulmonary metastasectomy a safe procedure with a low morbidity. However, surgical resection must be embedded in an individualized oncological concept.
    No preview · Article · Oct 2011 · European Surgery
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