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Surgical Utilization and Outcomes for Patients with Stage IV Melanoma in the Modern Immunotherapy Era

  • Melanoma
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Abstract

Background

The benefit of surgery for patients with stage IV melanoma in the modern era of effective immunotherapy is unclear. This study aimed to evaluate trends and outcomes after surgical resection of stage IV melanoma in the modern immunotherapy era.

Methods

Patients with stage IV melanoma who received surgery, immunotherapy, or both from 2012 to 2017 were identified from the National Cancer Database (NCDB). Demographics, facility-level characteristics, and use of immunotherapy were compared between patients who received surgery and those who did not. Multivariate Poisson regression modeling, Kaplan-Meier survival analysis, and Cox regression analysis were performed.

Results

The study identified 9800 patients with stage IV melanoma, and 2160 of these patients (22 %) underwent surgery. The patients who received surgery were more likely to be younger (P < 0.001), to have private insurance (P < 0.001), to have a higher median income (P = 0.008), and to receive treatment at academic/research programs (P < 0.001), whereas they were less likely to receive immunotherapy (33.7 % vs 36.6 %; P = 0.013). The patients who received immunotherapy had a lower likelihood of undergoing surgery (relative risk [RR], 0.82; 95 % confidence interval [CI[, 0.75–0.88; P < 0.001). The patients who received both surgery and immunotherapy had a better overall survival rate (hazard ratio [HR], 0.41; 95 % CI, 0.36–0.46; P < 0.01) than the patients who received neither immunotherapy nor surgery.

Conclusions

The use of immunotherapy was associated with a lower use of surgery for patients with stage IV melanoma. The patients with stage IV disease who received both surgery and immunotherapy had the highest overall survival rates.

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Authors and Affiliations

  1. Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA

    Thinzar M. Lwin MD, MS

  2. Division of Surgical Oncology, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Zoey Kaelberer BA, Mengyuan Ruan MS & George Molina MD, MPH

  3. Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA

    Genevieve Boland MD, PhD

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  1. Thinzar M. Lwin MD, MS
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  3. Mengyuan Ruan MS
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  4. George Molina MD, MPH
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Corresponding author

Correspondence to George Molina MD, MPH.

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Disclosures

Genevieve M. Boland has sponsored research agreements through her institution with Olink Proteomics, Teiko Bio, InterVenn Biosciences, Palleon Pharmaceuticals. She served on advisory boards for Iovance, Merck, Nektar Therapeutics, Novartis, and Ankyra Therapeutics. She consults for: Merck, InterVenn Biosciences, and Ankyra Therapeutics. She holds equity in Ankyra Therapeutics. The remaining authors have no conflicts of interest.

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Lwin, T.M., Kaelberer, Z., Ruan, M. et al. Surgical Utilization and Outcomes for Patients with Stage IV Melanoma in the Modern Immunotherapy Era. Ann Surg Oncol 30, 5005–5012 (2023). https://doi.org/10.1245/s10434-023-13543-y

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