转移性黑色素瘤转移灶切除术在有效全身治疗时代。
Metastasectomy for metastatic melanoma in the era of effective systemic therapy.
机构信息
Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
Texas A&M University, Department of Epidemiology and Biostatistics. School of Public Health, College Station, TX, USA.
出版信息
Am J Surg. 2024 May;231:65-69. doi: 10.1016/j.amjsurg.2023.04.020. Epub 2023 May 23.
INTRODUCTION
Effective systemic therapy (EST) in patients with metachronous metastatic melanoma (MMM) improves survival and alters surgical decision-making. Surgical metastasectomy is another treatment option, however, it is unclear if metastasectomy confers survival benefit. This study seeks to identify any survival benefit associated with surgical management of MMM.
METHODS
Patients with MMM from 2009 to 2021 were grouped by receipt of metastasectomy and treatment era (pre-versus post-EST). Overall survival (OS) was calculated from date of metastasis and evaluated with Kaplan-Meier analysis.
RESULTS
Our dataset identified 226 patients with MMM; 32% were diagnosed pre-EST. On Kaplan-Meier analysis, OS was improved for patients undergoing treatment post-versus pre-EST (p < 0.001). In the post-EST era, metastasectomy was associated with an increase in OS compared to no resection (p = 0.022).
CONCLUSIONS
In the post-EST group, EST paired with metastasectomy was associated with improved OS compared to the pre-EST group, suggesting persistent evidence of a survival benefit from metastasectomy.
简介
转移性黑色素瘤（MMM）患者接受有效全身治疗（EST）可改善生存并改变手术决策。手术转移灶切除术是另一种治疗选择，但尚不清楚转移灶切除术是否能带来生存获益。本研究旨在确定手术治疗 MMM 相关的生存获益。
方法
将 2009 年至 2021 年的 MMM 患者按接受转移灶切除术和治疗时代（EST 前与 EST 后）分组。从转移发生日期计算总生存期（OS），并采用 Kaplan-Meier 分析进行评估。
结果
我们的数据集确定了 226 例 MMM 患者；32%的患者在 EST 前被诊断。Kaplan-Meier 分析显示，接受 EST 后治疗的患者 OS 较 EST 前治疗有所改善（p<0.001）。在 EST 后时代，与未行切除术相比，转移灶切除术与 OS 增加相关（p=0.022）。
结论
在 EST 后组中，EST 联合转移灶切除术与 EST 前组相比，OS 得到改善，这表明转移灶切除术具有持续的生存获益证据。
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