Dugan Michelle M, Israeli Jacob, Chin Nicholas, Balsay-Patel Caitlyn, Huibers Anne, Fan Wenyi, Olofsson Bagge Roger, Zager Jonathan S
Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Ann Surg Oncol. 2025 May 24. doi: 10.1245/s10434-025-17490-8.
Acral lentiginous melanoma (ALM) has a worse prognosis than non-ALM subtypes and poorly understood genetic profile, limiting therapy options. This study compares outcomes of isolated limb infusion or perfusion (ILI/ILP) in patients with ALM or non-ALM.
A multi-institution retrospective review including patients with unresectable melanoma in-transit metastases (ITM) treated with ILI/ILP from 2002 to 2023.
A total of 364 patients were identified: 55% female; median age 71 years; 84 with ALM; 280 non-ALM. Acral lentiginous melanoma tumors had deeper Breslow thickness (4 mm vs. 2.9 mm, P = .005) and more frequent ulceration (38% vs. 27%, P = .03). On multivariable analysis, there were no differences in complete or overall response rates between ALM vs. non-ALM. Median follow-up was 3 years. On Kaplan-Meier analysis, median progression-free survival (PFS) was shorter for ALM (5.6 vs. 7.7 months, P = .02). Out-of-field PFS was shorter for ALM (9.6 vs. 15.3 months, P = .02). Disease-specific survival was shorter for ALM (3.5 vs. 7.8 years, P = .008). In-field PFS and overall survival were not different for ALM vs. non-ALM. On multivariable analysis, there were no differences in PFS (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.0-1.74; P = .05) or in-field PFS (HR 1.25, 95% CI 0.95-1.65; P = .1). Out-of-field PFS remained shorter for ALM (HR 1.44, 95% CI 1.09-1.91; P = .01).
Isolated limb infusion or perfusion is equally effective in achieving locoregional disease control in patients with ALM or non-ALM ITM. Disease-specific survival and out-of-field PFS were significantly shorter with ALM, likely reflective of ALM's more aggressive biology, and highlights a potential opportunity for systemic therapy with ILI/ILP to optimize local and distant disease control.
肢端雀斑样痣黑色素瘤（ALM）的预后比非ALM亚型更差，其基因特征了解甚少，限制了治疗选择。本研究比较了ALM或非ALM患者接受孤立肢体灌注或输注（ILI/ILP）的治疗结果。
一项多机构回顾性研究，纳入了2002年至2023年接受ILI/ILP治疗的无法切除的黑色素瘤皮下转移（ITM）患者。
共纳入364例患者：女性占55%；中位年龄71岁；84例为ALM；280例为非ALM。肢端雀斑样痣黑色素瘤肿瘤的Breslow厚度更深（4mm对2.9mm，P = 0.005），溃疡更常见（38%对27%，P = 0.03）。多变量分析显示，ALM与非ALM之间的完全缓解率或总缓解率无差异。中位随访时间为3年。根据Kaplan-Meier分析，ALM的中位无进展生存期（PFS）较短（5.6个月对7.7个月，P = 0.02）。ALM的野外PFS较短（9.6个月对15.3个月，P = 0.02）。ALM的疾病特异性生存期较短（3.5年对7.8年，P = 0.008）。ALM与非ALM的野内PFS和总生存期无差异。多变量分析显示，PFS（风险比[HR] 1.32，95%置信区间[CI] 1.0 - 1.74；P = 0.05）或野内PFS（HR 1.25，95% CI 0.95 - 1.65；P = 0.1）无差异。ALM的野外PFS仍然较短（HR 1.44，95% CI 1.09 - 1.91；P = 0.01）。
孤立肢体灌注或输注在实现ALM或非ALM ITM患者的局部区域疾病控制方面同样有效。ALM的疾病特异性生存期和野外PFS明显较短，这可能反映了ALM更具侵袭性的生物学特性，并突出了ILI/ILP全身治疗优化局部和远处疾病控制的潜在机会。
