John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA.
J Surg Oncol. 2011 Aug 1;104(2):111-5. doi: 10.1002/jso.21903. Epub 2011 Mar 4.
Patients with Stage IV melanoma have limited therapeutic options with few long-term survivors. Our goal was to study the impact of metastasectomy on survival in these patients.
Patients with Stage IV melanoma were identified from the Surveillance, Epidemiology, and End Results (SEER) database (1988-2006). Those who had metastasectomy performed were compared with patients that did not.
The median age of the study population (n = 4,229) was 63 years and median survival was 7 months. Patients who underwent metastasectomy (33.6%) had an improved median and 5-year overall survival as compared to patients who did not; 12 months versus 5 months and 16% versus 7% (P < 0.001). In patients with M1a disease (n = 1,994), this improvement of survival following metastasectomy was enhanced; median survival of 14 months versus 6 months and 5-year overall survival of 20% versus 9% (P < 0.001). Younger age and diagnosis from 2001 to 2006 were predictors of metastasectomy. Metastasectomy was an independent and significant predictor of survival for the entire cohort (HR 0.59, 95% CI 0.55-0.63).
Metastasectomy in patients with Stage IV melanoma may improve long-term survival. The true therapeutic benefit, if any, of metastatectomy needs to be determined by a randomized trial.
IV 期黑色素瘤患者的治疗选择有限，长期存活者寥寥无几。我们的目的是研究在这些患者中进行转移灶切除术对生存的影响。
从监测、流行病学和最终结果（SEER）数据库（1988-2006 年）中确定 IV 期黑色素瘤患者。将接受转移灶切除术的患者与未接受转移灶切除术的患者进行比较。
研究人群（n=4229）的中位年龄为 63 岁，中位生存时间为 7 个月。与未接受转移灶切除术的患者相比，接受转移灶切除术的患者（33.6%）的中位总生存期和 5 年总生存率均得到改善；12 个月与 5 个月，16%与 7%（P<0.001）。在 M1a 疾病患者（n=1994）中，转移灶切除术对生存的改善更为显著；中位生存时间为 14 个月与 6 个月，5 年总生存率为 20%与 9%（P<0.001）。年龄较轻和 2001 年至 2006 年的诊断是接受转移灶切除术的预测因素。转移灶切除术是整个队列生存的独立和显著预测因素（HR 0.59，95%CI 0.55-0.63）。
在 IV 期黑色素瘤患者中进行转移灶切除术可能会改善长期生存。转移灶切除术是否具有真正的治疗益处，需要通过随机试验来确定。
