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World Journal of Surgery

, Volume 43, Issue 7, pp 1809–1819 | Cite as

Treatment Strategies and Survival Trends for Anorectal Melanoma: Is it Time for a Change?

  • James P. Taylor
  • Miloslawa Stem
  • David Yu
  • Sophia Y. Chen
  • Sandy H. Fang
  • Susan L. Gearhart
  • Bashar Safar
  • Jonathan E. EfronEmail author
Original Scientific Report

Abstract

Background

Immunotherapy advances for the treatment of cutaneous melanoma question its efficacy in treating anorectal mucosal melanoma (ARMM). We aimed to identify the prevalence, current management, and overall survival (OS) for ARMM.

Methods

Review of patients with ARMM from 2004 to 2015 National Cancer Database. Factors associated with immunotherapy were identified using multivariable logistic regression. The primary outcome was 2- and 5-year OS. Subgroup analysis by treatment type was performed.

Results

A total of 1331 patients were identified with a significant increase in prevalence (2004: 6.99%, 2015: 10.53%). ARMM patients were older, white, on Medicare, and from the South. The most common treatment was surgery (48.77%), followed by surgery + radiation (11.75%), surgery + immunotherapy (8.68%), and surgery + chemotherapy (8.68%). 16.93% of patients received immunotherapy, with utilization increasing (7.24%: 2004, 21.27%: 2015, p < 0.001). Patients who received immunotherapy had a significantly better 2-year OS (42.47% vs. 49.21%, p < 0.001), and other therapies did not reveal a significant difference. Adjusted analysis showed no difference in 2- and 5-year OS based on therapy type.

Conclusion

The prevalence of ARMM has increased. The use of immunotherapy has increased substantially. Some survival benefit with the administration of immunotherapy may exist that has yet to be revealed. A more aggressive treatment paradigm is warranted.

Notes

Funding

Mr. Edwin Lewis provided generous support to Dr. Efron’s Department of Surgery Research Fund.

Compliance with ethical standards

Conflict of interest

None of the authors of this paper have any conflicts of interest.

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • James P. Taylor
    • 1
  • Miloslawa Stem
    • 1
  • David Yu
    • 1
    • 2
  • Sophia Y. Chen
    • 1
  • Sandy H. Fang
    • 1
  • Susan L. Gearhart
    • 1
  • Bashar Safar
    • 1
  • Jonathan E. Efron
    • 1
    Email author
  1. 1.Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Queen’s University School of MedicineKingstonCanada

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