The Hiram C. Polk Jr., MD, Department of Surgery, University of Louisville, 315 East Broadway, M-10, Louisville, KY 40202, USA.
The Hiram C. Polk Jr., MD, Department of Surgery, University of Louisville, 315 East Broadway, M-10, Louisville, KY 40202, USA.
Surg Oncol Clin N Am. 2020 Jul;29(3):485-495. doi: 10.1016/j.soc.2020.02.010.
Stage IV melanoma has a 5-year survival rate of 6%, but considerable advances have been made in systemic therapies. Systemic immunotherapy has achieved durable responses in up to 40% of patients, with similar improvements with targeted therapies. This has reshaped the landscape for surgery in stage IV melanoma. Metastasectomy can be considered in patients on systemic immunotherapy or targeted therapy with responding, stable, or isolated progressing lesions, oligometastatic disease, or long disease-free intervals. Surgery plays a role in providing tumor tissue for preparation of tumor-infiltrating lymphocytes for adoptive cell therapy. Surgical palliation plays a role in patients with symptomatic metastases.
IV 期黑色素瘤的 5 年生存率为 6%，但在系统治疗方面已取得重大进展。系统免疫疗法在多达 40%的患者中实现了持久反应，靶向治疗也取得了类似的改善。这改变了 IV 期黑色素瘤的手术格局。对于接受系统免疫治疗或靶向治疗、有反应、稳定或孤立进展病灶、寡转移疾病或无疾病间期较长的患者，可考虑转移灶切除术。手术在为过继细胞治疗制备肿瘤浸润淋巴细胞提供肿瘤组织方面发挥作用。对于有症状转移的患者，手术姑息治疗也有一定作用。
