Abstract
Purpose
Primary anorectal melanoma (ARM) accounts for approximately 1.2% of all melanomas and 16.5% of all mucosal melanomas. ARM is associated with the shortest interval to disease progression and the highest rate of metastasis; however, optimal therapeutic strategies for ARM remain controversial. This study aimed to assess the ideal surgical intervention for ARM and to determine the effect of immune checkpoint inhibitors (ICI).
Methods
We included 47 patients with ARM treated at the National Cancer Center Hospital in Japan from 2011 to 2020. We performed a survival analysis for each of these groups: (i) patients with ARM (n = 47); (ii) operable non-stage IV cases at initial presentation (n = 35); and (iii) stage IV cases (n = 32).
Results
The 5-year overall survival (OS) was 53.6%, and the median OS was 78.7 months in patients with ARM. No statistically significant difference in 5-year OS was found between rectal and anal sites (50.9% vs. 56.7%). In the non-stage IV subgroup, the type of surgery (abdominoperineal resection or wide local excision) did not correlate with OS (HR 1.85; 95% CI 0.46–7.5; p = 0.39). In the stage IV subgroup, the 2-year OS of the ICI treatment group was 61.4%, whereas that of the dacarbazine regimen group was 0% (p = 0.048).
Conclusion
Our ARM prognosis was better than that of previous studies. Our findings suggest that the availability of ICI therapy may improve survival in patients with advanced ARM. However, further research is warranted to identify both the clinical and molecular predictors of response to improve patient selection.
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Data availability
The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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This work was supported by the National Cancer Center Research and Development Fund (Grant number 29-A-3).
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by DO and KT. The first draft of the manuscript was written by DO, and all authors commented on subsequent versions of the manuscript. All authors read and approved the final manuscript.
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The study was approved by the Institutional Review Board of the NCCH (approval number: 2020–524). All aspects of our study were performed according to the Declaration of Helsinki.
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Ogata, D., Tsutsui, K., Namikawa, K. et al. Treatment outcomes and prognostic factors in 47 patients with primary anorectal malignant melanoma in the immune therapy era. J Cancer Res Clin Oncol 149, 749–755 (2023). https://doi.org/10.1007/s00432-022-03933-2
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DOI: https://doi.org/10.1007/s00432-022-03933-2