Surgical resection for metastatic melanoma to the liver - The John Wayne Cancer Institute and Sydney Melanoma Unit Experience
Surgical resection for metastatic melanoma to the liver - The John Wayne Cancer Institute and Sydney Melanoma Unit Experience
复制标题
DOI：
10.1001/archsurg.136.8.950
复制
发表时间：
2001-08-01
影响因子：
--
通讯作者：
Morton, DL
中科院分区：
文献类型：
--
作者：
Rose, DM;Essner, R;Morton, DL
假设：转移至肝脏的黑色素瘤并非无法治愈；完整的手术切除可以使选定的患者实现长期生存。背景：美国癌症联合委员会 IV 期黑色素瘤患者中有 10% 至 20% 被诊断出肝转移。手术切除尚未被普遍接受作为一种治疗选择，因为大多数患者会有其他部位的疾病，这将他们的中位生存期限制在 4 至 6 个月。然而，关于那些仅限于肝脏的疾病的患者切除后的结果几乎没有信息。 患者和方法：对加利福尼亚州圣莫尼卡约翰韦恩癌症研究所和澳大利亚悉尼悉尼黑色素瘤中心的前瞻性黑色素瘤数据库进行审查，确定了 1750 名肝转移患者，其中 34 名 (2%) 接受了探查，意图切除转移灶。通过单变量和多变量分析检查接受切除的患者组内的预后因素，并计算中位无病生存期（DFS）和总生存期（OS）。结果：在34例接受探查性开腹手术的患者中，24例（71%）接受了肝切除术，10例（29%）接受了探查但未切除。 18 名患者 (75%) 接受了完全手术切除，其余 6 名患者接受了不完全切除的姑息或减瘤手术。手术切除包括肺叶切除术（n=14）、肺段切除术（4）、非解剖性切除术（5）和扩大肺叶切除术（1）。切除病灶的中位数为 1 个，病灶大小中位数为 5 cm（范围：0.7-22 cm）。黑色素瘤初次诊断与发生肝转移之间的中位无病间隔为 58 个月（范围：0-264 个月）。 24 名接受手术切除的患者的中位 DFS 和 OS 估计分别为 12 个月（范围，0-147 个月）和 28 个月（范围，2-147 个月）。该组的五年 DFS 和 OS 分别为 12% 和 29%。单变量分析显示，宏观上，完全切除病变 (P=.001) 和组织学阴性切除边缘 (P=.03) 显着改善 DFS。通过手术治愈的患者的 OS 也往往有所改善 (P=.06)。接受手术切除的患者的中位 OS 为 28 个月，而仅接受探查的毛皮患者的中位 OS 为 4 个月（P
Hypothesis: Metastatic melanoma to the liver is not incurable; complete surgical resection can achieve longterm survival in selected patients.Background: Metastases to the liver are diagnosed in 10% to 20% of patients with American Joint Committee on Cancer stage IV melanoma. Surgical resection has not been generally accepted as a therapeutic option, as most patients will have other sites of disease that limit their survival to a median of only 4 to 6 months. However, there is little information on outcomes following resection in those patients with disease limited to the liver.Patients and Methods: Review of the prospective melanoma databases at the John Wayne Cancer Institute, Santa Monica, Calif, and the Sydney Melanoma Unit, Sydney, Australia, identified 1750 patients with hepatic metastases, of whom 34 (2%) underwent exploration with intent to resect the metastases. Prognostic factors within the group of patients who underwent resection were examined by univariate and multivariate analysis, and median disease-free survival (DFS) and overall survival (OS) were calculated.Results: Of 34 patients undergoing exploratory celiotomy, 24 (71%) underwent hepatic resection and 10 (29%) underwent exploration but not resection. Eighteen patients (75%) underwent complete surgical resection, while the remaining 6 underwent palliative or debulking procedures with incomplete resection. The operative resections included lobectomy (n=14), segmentectomy (4), nonanatomic resection (5), and extended lobectomy (1). The median number of resected lesions was 1, and median lesion size was 5 cm (range, 0.7-22 cm). The median disease-free interval between initial diagnosis of melanoma and development of hepatic metastases was 58 months (range, 0-264 months). Median DFS and OS estimates in the 24 patients who underwent surgical resection were 12 months (range, 0-147 months) and 28 months (range, 2-147 months), respectively. Five-year DFS and OS in this group were 12% and 29%. Macroscopically, complete resection of disease (P=.001) and histologically negative resection margins (P=.03) significantly improved DFS by univariate analysis. Patients rendered surgically free of disease also tended to have improved OS (P=.06). Median OS was 28 months for patients who underwent surgical resection compared with 4 months fur patients who underwent exploration only (P