Stoff Ronen, Yalon Mariana, Thorpe Matthew P, Flotte Thomas J, Block Matthew S, Hieken Tina J
Department of Oncology, Mayo Clinic, Rochester, MN, USA.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2025 Aug 26. doi: 10.1245/s10434-025-18191-y.
Clinical stage III melanoma has a high recurrence rate following surgical dissection. The use of neoadjuvant treatment has been shown to improve long-term outcomes when compared with up-front surgery, with the pathological response being the best predictor. Biomarkers predicting responses and possibly allowing surgical de-escalation are missing. We aimed at assessing the correlation between post-treatment positron emission tomography-computed tomography (PET-CT) results and the pathological and long-term outcomes in a cohort of patients treated with a variety of regimens.
With IRB approval, we collected data on all patients with stage III melanoma treated with neoadjuvant intent at our institution since 2011 and assessed the association between their baseline features, post-treatment PET-CT findings, surgical pathological findings, and long-term outcomes.
In total, 60 patients were identified; the median age was 61 years and 50% were males. The most common regimens used were immunotherapy (IO) in 42% and IO combined with targeted therapy (TT) in 48%. The imaging and pathological response rates were correlated at 60% and 65%, respectively. Both imaging and pathological response rates were higher for those treated with IO+TT than those with IO only, yet the presence of a major pathological response was predictive of a decreased risk of recurrence only in patients treated with IO. Overall, 67% had discordance in the number of involved lymph nodes between the PET-CT and pathological findings. PET-CT underestimation of lymph node involvement was associated with recurrence in those treated with IO only.
Post-neoadjuvant PET-CT findings should be interpreted with caution when considering the extent of the surgical dissection.
临床III期黑色素瘤手术切除后复发率高。与直接手术相比，新辅助治疗已被证明可改善长期预后，病理反应是最佳预测指标。目前缺乏预测反应并可能允许手术降级的生物标志物。我们旨在评估一组接受多种治疗方案的患者中，治疗后正电子发射断层扫描-计算机断层扫描（PET-CT）结果与病理及长期预后之间的相关性。
经机构审查委员会批准，我们收集了自2011年以来在本机构接受新辅助治疗的所有III期黑色素瘤患者的数据，并评估了他们的基线特征、治疗后PET-CT结果、手术病理结果和长期预后之间的关联。
共纳入60例患者；中位年龄为61岁，50%为男性。最常用的治疗方案是免疫治疗（IO），占42%，IO联合靶向治疗（TT），占48%。影像学和病理反应率分别为60%和65%，两者相关。IO+TT治疗患者的影像学和病理反应率均高于单纯IO治疗患者，但主要病理反应仅在接受IO治疗的患者中可预测复发风险降低。总体而言，67%的患者PET-CT与病理结果显示的受累淋巴结数量不一致。PET-CT对淋巴结受累情况的低估与单纯接受IO治疗患者的复发有关。
在考虑手术切除范围时，应谨慎解读新辅助治疗后的PET-CT结果。
