Annals of Surgical Oncology

, Volume 14, Issue 10, pp 2847–2853 | Cite as

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

  • Heather B. Neuman
  • Ami Patel
  • Christine Hanlon
  • Jedd D. Wolchok
  • Alan N. Houghton
  • Daniel G. Coit
Melanomas

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Melanoma Pulmonary Metastases Survival Stage-IV M1b Surgery Recurrence 

References

  1. 1.
    Brand CU, Ellwanger U, Stroebel W, et al. Prolonged survival of 2 years or longer for patients with disseminated melanoma. An analysis of related prognostic factors. Cancer 1997; 79(12):2345–2353PubMedCrossRefGoogle Scholar
  2. 2.
    Barth A, Wanek LA, Morton DL. Prognostic factors in 1,521 melanoma patients with distant metastases. J Am Coll Surg 1995; 181(3):193–201PubMedGoogle Scholar
  3. 3.
    Manola J, Atkins M, Ibrahim J, Kirkwood J. Prognostic factors in metastatic melanoma: a pooled analysis of Eastern Cooperative Oncology Group trials. J Clin Oncol. 2000; 18(22):3782–3793PubMedGoogle Scholar
  4. 4.
    Balch CM, Soong SJ, Murad TM, Smith JW, Maddox WA, Durant JR. A multifactorial analysis of melanoma. IV. Prognostic factors in 200 melanoma patients with distant metastases (stage III). J Clin Oncol 1983; 1(2):126–134PubMedGoogle Scholar
  5. 5.
    Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 2001; 19(16):3622–3634PubMedGoogle Scholar
  6. 6.
    Tafra L, Dale PS, Wanek LA, Ramming KP, Morton DL. Resection and adjuvant immunotherapy for melanoma metastatic to the lung and thorax. J Thorac Cardiovasc Surg 1995; 110(1):119–129PubMedCrossRefGoogle Scholar
  7. 7.
    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; 133(1):104–110PubMedCrossRefGoogle Scholar
  8. 8.
    Harpole DH Jr, Johnson CM, Wolfe WG, George SL, Seigler HF. Analysis of 945 cases of pulmonary metastatic melanoma. J Thorac Cardiovasc Surg 1992; 103(4):743–750PubMedGoogle Scholar
  9. 9.
    Andrews S, Robinson L, Cantor A, DeConti RC. Survival after surgical resection of isolated pulmonary metastases from malignant melanoma. Cancer Control 2006; 13(3):218–223PubMedGoogle Scholar
  10. 10.
    Mathisen DJ, Flye MW, Peabody J. The role of thoracotomy in the management of pulmonary metastases from malignant melanoma. Ann Thorac Surg 1979; 27(4):295–299PubMedCrossRefGoogle Scholar
  11. 11.
    Leo F, Cagini L, Rocmans P, et al. Lung metastases from melanoma: when is surgical treatment warranted? Br J Cancer 2000; 83(5):569–572PubMedCrossRefGoogle Scholar
  12. 12.
    Karp NS, Boyd A, DePan HJ, Harris MN, Roses DF. Thoracotomy for metastatic malignant melanoma of the lung. Surgery 1990; 107(3):256–261PubMedGoogle Scholar
  13. 13.
    Gorenstein LA, Putnam JB, Natarajan G, Balch CA, Roth JA. Improved survival after resection of pulmonary metastases from malignant melanoma. Ann Thorac Surg 1991; 52(2):204–210PubMedCrossRefGoogle Scholar
  14. 14.
    Thayer JO Jr, Overholt RH. Metastatic melanoma to the lung: long-term results of surgical excision. Am J Surg 1985; 149(4):558–562PubMedCrossRefGoogle Scholar
  15. 15.
    Ollila DW, Stern SL, Morton DL. Tumor doubling time: a selection factor for pulmonary resection of metastatic melanoma. J Surg Oncol 1998; 69(4):206–211PubMedCrossRefGoogle Scholar
  16. 16.
    Essner R, Lee JH, Wanek LA, Itakura H, Morton DL. Contemporary surgical treatment of advanced-stage melanoma. Arch Surg 2004; 139(9):961–967PubMedCrossRefGoogle Scholar
  17. 17.
    Karakousis CP, Velez A, Driscoll DL, Takita H. Metastasectomy in malignant melanoma. Surgery 1994; 115(3):295–302PubMedGoogle Scholar
  18. 18.
    Pogrebniak HW, Stovroff M, Roth JA, Pass HI. Resection of pulmonary metastases from malignant melanoma: results of a 16-year experience. Ann Thorac Surg 1988; 46(1):20–23PubMedCrossRefGoogle Scholar
  19. 19.
    Wong JH, Euhus DM, Morton DL. Surgical resection for metastatic melanoma to the lung. Arch Surg 1988; 123(9):1091–1095PubMedGoogle Scholar
  20. 20.
    Balch CM, Buzaid AC, Soong SJ, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 2001; 19(16):3635–3648PubMedGoogle Scholar
  21. 21.
    Sasse A, Sasse E, Clark L, Ulloa L, Clark O. Chemoimmunotherapy versus chemotherapy for metastatic malignant melanoma. Cochrane Database Syst Rev 2007(1):CD005413Google Scholar
  22. 22.
    Allen PJ, Coit DG. The surgical management of metastatic melanoma. Ann Surg Oncol 2002; 9(8):762–770PubMedCrossRefGoogle Scholar
  23. 23.
    Young SE, Martinez SR, Essner R. The role of surgery in treatment of stage IV melanoma. J Surg Oncol 2006; 94(4):344–351PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Heather B. Neuman
    • 1
  • Ami Patel
    • 1
  • Christine Hanlon
    • 1
  • Jedd D. Wolchok
    • 2
  • Alan N. Houghton
    • 2
  • Daniel G. Coit
    • 1
  1. 1.Gastric and Mixed Tumor Service, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of MedicineMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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