Institute of Clinical Surgery, University of Trieste, Trieste, Italy.
Langenbecks Arch Surg. 2009 Nov;394(6):1079-84. doi: 10.1007/s00423-008-0312-8. Epub 2008 Mar 4.
Survival rates of patients with stage IV melanoma are poor: Median survival is 7-8 months and 5-year survival rates about 5%. There is no agreement on the role of surgery at this stage. Most patients with metastatic melanoma are not able to undergo resection and usually are sent to systemic chemo- and immunotherapy.
Eighty-four patients operated on for stage IV melanoma were evaluated. Of them, 61.9% were submitted to reiterative surgery with 168 operations and 182 surgical procedures overall. A total of 90.5% was submitted to adjuvant therapies according to aggressive and reiterated schedules: chemotherapy, immunotherapy, dendritic cells vaccine, infusion of tumor infiltrating lymphocytes, local therapies as electrochemotherapy.
The mean overall survival (Kaplan-Meier) was 56.7 months (1 year: 72.1%, 3 years: 46.5%, 5 years: 23.16%). The survival of reiterative surgery was significatively longer than single surgery (62.7 vs 42.4 months, median 50.9 vs 16.0), p = 0.03. Multivariated Cox analysis was performed for disease-free interval, repeated surgery, adjuvant therapies, and site of metastasis according to the American Joint Committee on Cancer: Reiterative surgery was shown as an independent prognostic factor (p < 0.05).
Metastatic resection associated with adjuvant therapy may improve overall survival and, in some instances, can provide long-term survival, whatever site and numbers of metastasis. In our series, reiterative surgery was more significatively efficient in improving survival than single-time surgery.
IV 期黑色素瘤患者的生存率较差：中位生存时间为 7-8 个月，5 年生存率约为 5%。对于这一阶段的手术作用尚无共识。大多数转移性黑色素瘤患者无法进行切除，通常会接受全身化疗和免疫治疗。
评估了 84 例接受 IV 期黑色素瘤手术的患者。其中，61.9%的患者接受了重复手术，共进行了 168 次手术和 182 次手术。根据积极和重复的方案，共有 90.5%的患者接受了辅助治疗：化疗、免疫治疗、树突状细胞疫苗、肿瘤浸润淋巴细胞输注、电化学疗法等局部治疗。
总生存时间（Kaplan-Meier）的平均值为 56.7 个月（1 年：72.1%，3 年：46.5%，5 年：23.16%）。重复手术的生存时间明显长于单次手术（62.7 与 42.4 个月，中位 50.9 与 16.0 个月，p = 0.03）。根据美国癌症联合委员会（AJCC）对无病间隔、重复手术、辅助治疗和转移部位进行多变量 Cox 分析：重复手术被证明是一个独立的预后因素（p < 0.05）。
转移性切除术联合辅助治疗可能提高总生存率，并且在某些情况下，无论转移部位和数量如何，都可以提供长期生存。在我们的系列中，重复手术比单次手术更能显著提高生存率。
