Dheer Anushka, Tortorello Gabriella N, Shafique Neha, Farooq Mohammad S, Mitchell Tara C, Xu Xiaowei, Miura John T, Karakousis Giorgos C
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Surg Oncol. 2025 Mar;131(3):365-370. doi: 10.1002/jso.27933. Epub 2024 Oct 3.
The impact of neoadjuvant immunotherapy (NIT) on overall survival (OS) in patients with resectable stage III melanoma remains unknown. We sought to identify factors associated with receipt of NIT and survival outcomes in patients with clinical stage III melanoma undergoing surgery.
The National Cancer Database (2016-2020) was used to identify patients with clinical stage III melanoma who underwent surgery and received either NIT or adjuvant immunotherapy (AIT) only. Multivariable regression, Kaplan-Meier, and Cox proportional hazard methods were used to analyze variables of interest.
Patients with clinical N3 disease had 2.5 times the odds of NIT compared to those with N1 disease (95% CI 1.74-3.49). There was no difference in 3-year OS between the two cohorts: 79% (95% CI 73%-85%) for NIT patients and 75% (95% CI 73%-76%) for AIT patients (p = 0.078). Patients with N2/N3 disease had improved 3-year OS of 79% with NIT versus 71% for AIT-only (HR 0.61, 95% CI 0.38-0.97, p = 0.037).
NIT is given more selectively to clinical stage III patients with more advanced N category disease. Despite significant differences in N category between groups, there was no difference in OS observed at 3 years, and NIT was associated with a survival advantage among N2/N3 patients.
新辅助免疫疗法（NIT）对可切除的III期黑色素瘤患者总生存期（OS）的影响尚不清楚。我们试图确定接受NIT治疗的相关因素以及接受手术的临床III期黑色素瘤患者的生存结局。
利用国家癌症数据库（2016 - 2020年）确定接受手术且仅接受NIT或辅助免疫疗法（AIT）的临床III期黑色素瘤患者。采用多变量回归、Kaplan-Meier法和Cox比例风险法分析感兴趣的变量。
与N1期疾病患者相比，临床N3期疾病患者接受NIT治疗的几率是其2.5倍（95%CI 1.74 - 3.49）。两组患者的3年总生存期无差异：NIT组患者为79%（95%CI 73% - 85%），AIT组患者为75%（95%CI 73% - 76%）（p = 0.078）。N2/N3期疾病患者接受NIT治疗的3年总生存期改善至79%，而仅接受AIT治疗的患者为71%（风险比0.61，95%CI 0.38 - 0.97，p = 0.037）。
NIT更有选择性地应用于N分期疾病更晚期的临床III期患者。尽管两组之间N分期存在显著差异，但3年时观察到的总生存期无差异，且NIT与N2/N3期患者的生存优势相关。
