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Surgical Management of Melanoma Lung Metastasis: An Analysis of Survival Outcomes in 292 Consecutive Patients

  • Melanomas
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The role of surgical resection of melanoma lung metastases (MLM) remains controversial. Some authorities advocate an aggressive surgical approach, while others recommend a conservative strategy. This study sought to identify the clinicopathologic and predictors of outcome after surgical management of MLM in a large series of melanoma patients from a single institution.

Methods

All patients undergoing surgical management of MLM between November 1984 and April 2010 were identified and predictors of outcome analyzed.

Results

Of the 292 patients eligible for the study, 112 (38%) had previously undergone surgery for nonpulmonary recurrences. Four patients (1%) died within 30 days of surgery for MLM. The median progression-free survival time was 10 months. The median overall survival and 3- and 5-year survival were 23 months [95% confidence interval (CI) 17–30], 41 and 34%, respectively. Metastasis size >2 cm [hazard ratio (HR) 1.4, 95% CI 1.0–1.8, P = 0.03, HR 1.6, 95% CI 1.2–2.2; P = 0.002] and positive surgical margin (HR 1.5, 95% CI 1.2–1.9, P < 0.001; HR 1.4, 95% CI 1.1–1.7, P = 0.003) were independently associated with poorer progression-free survival and overall survival, respectively. The presence of more than one metastasis (HR 1.4, 95% CI 1.1–1.7, P = 0.013) was independently associated with poorer overall survival.

Conclusions

The results support the role of pulmonary metastasectomy in selected patients with MLM. Patients with small (<2 cm) and solitary tumors that can be completely resected with a negative margin are most likely to experience prolonged survival.

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References

  1. Balch CM, Soong S-J, Atkins MB, et al. An evidence-based staging system for cutaneous melanoma. CA Cancer J Clin. 2004;4:131–49.

    Article  Google Scholar 

  2. Crosby T, Fish R, Coles B, Mason MD. Systemic treatments for metastatic cutaneous melanoma. Cochrane Database Syst Rev. 2000;(2):CD001215.

  3. Ives NJ, Stowe RL, Lorigan P, Wheatley K. Chemotherapy compared with biochemotherapy for the treatment of metastatic melanoma: a meta-analysis of 18 trials involving 2,621 patients. J Clin Oncol. 2007;5:5426–34.

    Article  Google Scholar 

  4. Hersey P, Bastholt L, Chiarion-Sileni V, et al. Small molecules and targeted therapies in distant metastatic disease. Ann Oncol. 2009;20(Suppl. 6):vi35–40.

    Article  PubMed  Google Scholar 

  5. Thompson JF, Scolyer RA, Kefford RF. Cutaneous melanoma. Lancet. 2005;65(9460):687–701.

    Google Scholar 

  6. Pastorino U, Buyse M, et al. International Registry of Lung Metastases Writing Committee. Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg. 1997;13:37–49.

    Google Scholar 

  7. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;7:6199–206.

    Article  Google Scholar 

  8. Petersen RP, Hanish SI, Haney JC, et al. Improved survival with pulmonary metastasectomy: an analysis of 1720 patients with pulmonary metastatic melanoma. J Thorac Cardiovasc Surg. 2007;33:104–10.e2.

    Google Scholar 

  9. Tafra L, Dale PS, Wanek LA, et al. Resection and adjuvant immunotherapy for melanoma metastatic to the lung and thorax. J Thorac Cardiovasc Surg. 1995;10:119–29.

    Article  Google Scholar 

  10. Ollila DW, Stern SL, Morton DL. Tumor doubling time: a selection factor for pulmonary resection of metastatic melanoma. J Surg Oncol. 1998;9:206–11.

    Article  Google Scholar 

  11. Lee JH, Gulec SA, Kyshtoobayeva A, et al. Biological factors, tumor growth kinetics, and survival after metastasectomy for pulmonary melanoma. Ann Surg Oncol. 2009;6:2834–9.

    Article  Google Scholar 

  12. Fuster D, Chiang S, Johnson G, et al. Is 18F-FDG PET more accurate than standard diagnostic procedures in the detection of suspected recurrent melanoma? J Nucl Med. 2004;5:1323–7.

    Google Scholar 

  13. García-Yuste M, Cassivi S, Paleru C. Thoracic lymphatic involvement in patients having pulmonary metastasectomy: incidence and the effect on prognosis. J Thorac Oncol. 2010;(6 Suppl 2):S166–9.

  14. Pfannschmidt J, Klode J, Muley T, et al. Nodal involvement at the time of pulmonary metastasectomy: experiences in 245 patients. Ann Thorac Surg. 2006;1:448–54.

    Article  Google Scholar 

  15. Leo F, Cagini L, Rocmans P, et al. Lung metastases from melanoma: when is surgical treatment warranted? Br J Cancer. 2000;3:569–72.

    Article  Google Scholar 

  16. Neuman HB, Patel A, Hanlon C, et al. Stage-IV melanoma and pulmonary metastases: factors predictive of survival. Ann Surg Oncol. 2007;4:2847–53.

    Article  Google Scholar 

  17. Andrews S, Robinson L, Cantor A, DeConti RC. Survival after surgical resection of isolated pulmonary metastases from malignant melanoma. Cancer Control. 2006;3:218–23.

    Google Scholar 

  18. de Wilt JH, Farmer SE, Scolyer RA, et al. Isolated melanoma in the lung where there is no known primary site: metastatic disease or primary lung tumor? Melanoma Res. 2005;5:531–7.

    Article  Google Scholar 

  19. Scolyer RA, Bishop JF, Thompson JF. Primary melanoma of the lung, Chapter 24. In: Raghavan D, Brecher ML, Johnson DH, et al., editors. Textbook of uncommon cancer. Hoboken, NJ: Wiley-Blackwell Interscience; 2006. p. 293–97.

  20. Morton DL, Mozzillo N, Thompson JF. An international, randomized, double-blind, phase 3 study of the specific active immunotherapy agent, onamelatucel-L (Canvaxin), compared to placebo as a post-surgical adjvuvant in AJCC stage IV melanoma (plenary talk). Presented at the Society of Surgical Oncology Cancer Symposium, 59th Annual Meeting, San Diego; 2006.

  21. Gorenstein LA, Putnam JB, Natarajan G, et al. Improved survival after resection of pulmonary metastases from malignant melanoma. Ann Thorac Surg. 1991;2:204–10.

    Article  Google Scholar 

  22. Klapper JA, Davis JL, Ripley RT, et al. Thoracic metastasectomy for adoptive immunotherapy of melanoma: a single-institution experience. J Thorac Cardiovasc Surg. 2010;140:1276–82.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Melanoma Institute Australia, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Terence C. Chua MBBS, Richard A. Scolyer MD & John F. Thompson MD

  2. Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Terence C. Chua MBBS, Tristan D. Yan PhD, Brian C. McCaughan MBBS (Hons) & John F. Thompson MD

  3. Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Richard A. Scolyer MD

  4. Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Richard A. Scolyer MD

  5. Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Catherine W. Kennedy BSc, Tristan D. Yan PhD & Brian C. McCaughan MBBS (Hons)

  6. Strathfield Private Hospital Campus, The University of Sydney, Strathfield, NSW, Australia

    Catherine W. Kennedy BSc

  7. The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia

    Catherine W. Kennedy BSc, Tristan D. Yan PhD & Brian C. McCaughan MBBS (Hons)

  8. Melanoma Institute Australia, The Poche Centre, 40 Rocklands Road, North Sydney, NSW, 2060, Australia

    John F. Thompson MD

Authors
  1. Terence C. Chua MBBS
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  2. Richard A. Scolyer MD
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  3. Catherine W. Kennedy BSc
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  4. Tristan D. Yan PhD
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  5. Brian C. McCaughan MBBS (Hons)
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  6. John F. Thompson MD
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Corresponding author

Correspondence to John F. Thompson MD.

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Chua, T.C., Scolyer, R.A., Kennedy, C.W. et al. Surgical Management of Melanoma Lung Metastasis: An Analysis of Survival Outcomes in 292 Consecutive Patients. Ann Surg Oncol 19, 1774–1781 (2012). https://doi.org/10.1245/s10434-011-2197-y

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  • DOI: https://doi.org/10.1245/s10434-011-2197-y

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