Current Patterns of Treatment and Outcomes in Advanced Melanoma at a Single Institution.
Current Patterns of Treatment and Outcomes in Advanced Melanoma at a Single Institution.
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单一机构晚期黑色素瘤的当前治疗模式和结果。
DOI：
10.1016/j.jss.2023.05.024
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Wachtel,Heather
中科院分区：
文献类型：
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作者：
Rose,MichelleA;Miura,John;Sharon,Cimarron;Ermer,JaeP;Karakousis,Giorgos;Wachtel,Heather
前言晚期黑色素瘤的治疗已经被新的系统治疗所改变。本研究的目的是描述目前的利用模式的免疫治疗方面的生存结局在晚期melanoma.MethodsWe进行了一项回顾性队列研究，在我们的机构（2009年至2019年）与第3和第4阶段的黑色素瘤患者。主要结局包括总生存期（OS）和无进展生存期（PFS）。Kaplan-Meier生存分析和考克斯比例风险回归分析评估协变量和生存outcome.ResultsOf 244例患者，5年OS为62.4%之间的关联。血管侵犯（HR = 2.462，P = 0.030）与PFS缩短相关，而女性（HR = 0.324，P = 0.010）与PFS延长相关。残留肿瘤（HR = 146，P= 0.006）和4期疾病（HR = 3.349，P = 0.011）与较短的OS相关。在研究期间，免疫治疗的使用从2%增加到23%，新辅助免疫治疗的使用也增加到2016年。免疫治疗给药的时间与生存率无显著相关性。193例接受2种或更多种治疗类型的患者中，最常见的治疗顺序是手术，其次是免疫治疗（n= 117，60.6%）。在这个异质性队列中，免疫治疗的时机与生存结局之间没有显著相关性。
IntroductionTreatment of advanced melanoma has been transformed by novel systemic therapies. The purpose of this study is to describe the current utilization patterns of immunotherapies with respect to survival outcomes in advanced melanoma.MethodsWe performed a retrospective cohort study of patients with Stage 3 and 4 melanoma at our institution (2009-2019). Primary outcomes included overall survival (OS) and progression free survival (PFS). Kaplan–Meier survival analysis and Cox proportional hazards regression analysis evaluated associations between covariates and survival outcomes.ResultsOf 244 patients, 5-y OS was 62.4%. Lymphovascular invasion (hazard ratio [HR] = 2.462,P= 0.030) was associated with shorter PFS whereas female gender (HR = 0.324,P= 0.010) was associated with longer PFS. Residual tumor (HR = 146,P= 0.006) and Stage 4 disease (HR = 3.349,P= 0.011) were associated with shorter OS. Use of immunotherapy increased from 2% to 23% over the study period, and use of neoadjuvant immunotherapy also increased up to 2016. Timing of immunotherapy administration was not significantly associated with survival. Of the 193 patients who received 2 or more treatment types, the most common treatment sequence was surgery followed by immunotherapy (n= 117, 60.6%).ConclusionsImmunotherapy is increasingly used for treatment of advanced melanoma. In this heterogeneous cohort, there was no significant association between timing of immunotherapy and survival outcomes.