Department of Surgical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.
Ann Surg Oncol. 2022 Jun;29(6):3709-3723. doi: 10.1245/s10434-022-11351-4. Epub 2022 Feb 6.
Evidence on the role of curative metastasectomy (CM) for malignant melanoma (MM) patients is limited, especially in the current era of effective systemic therapy. A systematic review and meta-analysis were performed to ascertain the role of CM compared with incomplete or nonsurgical treatment for patients with MM.
Medline, Embase, and Scopus databases were searched for studies investigating CM for MM until 30 September 2021. The review included studies that compared CM with no-CM and reported a hazard ratio (HR) after multivariate analysis for overall survival. A random-effects model with inverse variance was used to calculate pooled HR. The Newcastle-Ottawa Scale was used to assess the risk of bias.
For the final analysis, 40 studies including 31,282 patients (CM, 9958; no-CM, 21,324) were considered. Compared with no-CM, CM was associated with a significantly lower risk of death (HR, 0.42; 95% confidence interval [CI], 0.38-0.47; p < 0.00001). Subgroup analysis showed that the outcome was independent of the effective systemic therapy and anatomic location of metastasis. An unfavorable prognosis was associated with advancing age, elevated lactate dehydrogenase (LDH), male gender, prior stage 3 disease, multiple metastases and organ sites, and shorter disease-free interval.
Curative metastasectomy for MM is associated with a lower risk of death than non-curative treatment methods. Selection bias and underlying weakness of studies reduced the strength of evidence in this review. However, CM should be a part of the multimodality treatment of MM whenever technically feasible.
关于根治性转移切除术（CM）治疗恶性黑色素瘤（MM）患者的作用的证据有限，尤其是在当前有效的全身治疗时代。进行了系统评价和荟萃分析，以确定 CM 与 MM 患者不完全或非手术治疗相比的作用。
直到 2021 年 9 月 30 日，在 Medline、Embase 和 Scopus 数据库中搜索了研究 CM 治疗 MM 的研究。该综述包括比较 CM 与无-CM 并报告多变量分析后总生存率的危险比（HR）的研究。使用逆方差的随机效应模型计算合并 HR。纽卡斯尔-渥太华量表用于评估偏倚风险。
最终分析纳入了 40 项研究，共 31282 例患者（CM，9958 例；无-CM，21324 例）。与无-CM 相比，CM 与死亡风险显著降低相关（HR，0.42；95%置信区间 [CI]，0.38-0.47；p < 0.00001）。亚组分析表明，该结果与有效的全身治疗和转移部位无关。预后不良与年龄较大、乳酸脱氢酶（LDH）升高、男性、先前的 3 期疾病、多个转移和器官部位以及较短的无病间隔有关。
与非治愈性治疗方法相比，MM 的根治性转移切除术与死亡风险降低相关。选择偏倚和研究的潜在弱点降低了本综述中证据的强度。然而，只要在技术上可行，CM 就应成为 MM 多模式治疗的一部分。
