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

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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.

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Funding

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

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Authors and Affiliations

  1. Johns Hopkins University School of Medicine, 733 N. Broadway, Suite G-45, Baltimore, MD, 21205, USA

    James P. Taylor, Miloslawa Stem, David Yu, Sophia Y. Chen, Sandy H. Fang, Susan L. Gearhart, Bashar Safar & Jonathan E. Efron

  2. Queen’s University School of Medicine, Kingston, Canada

    David Yu

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  1. James P. Taylor
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Correspondence to Jonathan E. Efron.

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Disclaimers: The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Taylor, J.P., Stem, M., Yu, D. et al. Treatment Strategies and Survival Trends for Anorectal Melanoma: Is it Time for a Change?. World J Surg 43, 1809–1819 (2019). https://doi.org/10.1007/s00268-019-04960-w

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