Surgery for Unresectable Stage IIIC and IV Melanoma in the Era of New Systemic Therapy
Surgery for Unresectable Stage IIIC and IV Melanoma in the Era of New Systemic Therapy
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DOI：
10.3390/cancers12051176
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发表时间：
2020-05-01
期刊：
影响因子：
5.2
通讯作者：
van Akkooi, Alexander C. J.
中科院分区：
文献类型：
--
作者：
Blankenstein, Stephanie A.;Aarts, Maureen J. B.;van Akkooi, Alexander C. J.
在过去的十年里，由于新的系统疗法的发展，转移性黑色素瘤患者的手术治疗机会重新出现。这项研究的目的是提供关于不能切除的IIIC和IV期黑色素瘤患者的手术结果的数据，这些患者以前曾接受过免疫治疗或靶向治疗。从荷兰黑色素瘤治疗登记处(DMTR)摘录了154名患者的数据，这些患者获得了系统治疗的疾病控制并接受了随后的手术。疾病控制定义为完全缓解(CR)，3.2%的患者出现；部分缓解(PR)，46.1%的患者；或稳定疾病(SD)，44.2%的患者。术后中位随访10.0个月(四分位数范围4-22)，中位总生存期(OS)未达到，中位无进展生存期(PFS)为9.0个月(95%可信区间6.3-11.7)。与稳定或进展的疾病相比，术后首次随访的CR或PR与更好的OS和PFS相关(p<；0.001)。我们的结论是，选择的患者在通过系统治疗实现疾病控制后，可以从手术中受益。
Opportunities for surgical treatment in metastatic melanoma patients have re-emerged due to the development of novel systemic therapeutics over the past decade. The aim of this study is to present data on outcomes of surgery in patients with unresectable stage IIIC and IV melanoma, who have previously been treated with immunotherapy or targeted therapy. Data was extracted from the Dutch Melanoma Treatment Registry (DMTR) on 154 patients obtaining disease control to systemic therapy and undergoing subsequent surgery. Disease control was defined as a complete response (CR), which was seen in 3.2% of patients; a partial response (PR), seen in 46.1% of patients; or stable disease (SD), seen in 44.2% of patients. At a median follow-up of 10.0 months (interquartile range 4-22) after surgery, the median overall survival (OS) had not been reached in our cohort and median progression-free survival (PFS) was 9.0 months (95% CI 6.3-11.7). A CR or PR at first follow-up after surgery was associated with both a better OS and PFS compared to stable or progressive disease (p < 0.001). We conclude that selected patients can benefit from surgery after achieving disease control with systemic therapy.