Introduction: Patients with metastatic melanoma to the lung typically have poor outcomes. Although a pulmonary metastasectomy for selected patients has been shown to improve survival, the role of surgical resection following the introduction of immunotherapy for metastatic melanoma is unknown. The objective of this study was to determine predictors of survival for patients with melanoma metastatic to the lung in the era of immunotherapy. Methods: In this retrospective study, data from the National Cancer Database were abstracted for patients with melanoma lung metastases. The overall survival was evaluated using Kaplan–Meier and Cox proportional hazard analysis, adjusting for previously described risk factors for mortality. Patients with concomitant metastases to organs other than the lung were excluded from the study. Results: A total of 625 patients with lung metastases at the time of a skin melanoma diagnosis were identified. A total of 280 patients underwent a pulmonary metastasectomy, 267 received immunotherapy, and 78 were treated with both a metastasectomy and immunotherapy. During a median follow-up time of 34.6 months [IQR: 14.2, 75.9], a metastasectomy was found to offer significantly improved survival compared to immunotherapy alone. No difference was noted between a metastasectomy and a combination of a metastasectomy and immunotherapy in the adjusted Cox proportional hazard model. Conclusions: When statistical models were adjusted for risk factors, a metastasectomy maintained a significant survival advantage compared to immunotherapy. The addition of immunotherapy to the treatment of patients treated with a pulmonary metastasectomy did not improve survival. Our findings support the role of surgery for patients with pulmonary metastatic melanoma.
引言：肺转移性黑色素瘤患者通常预后不良。虽然对特定患者进行肺转移灶切除术已被证实可提高生存率，但在免疫疗法应用于转移性黑色素瘤治疗后，手术切除的作用尚不明确。本研究旨在确定免疫治疗时代肺转移性黑色素瘤患者的生存预测因素。方法：本回顾性研究从国家癌症数据库中提取肺转移性黑色素瘤患者数据。采用Kaplan-Meier法和Cox比例风险模型评估总生存期，并对已知的死亡风险因素进行校正。研究排除了除肺部外同时存在其他器官转移的患者。结果：共纳入625例皮肤黑色素瘤确诊时即存在肺转移的患者。其中280例接受肺转移灶切除术，267例接受免疫治疗，78例同时接受转移灶切除术与免疫治疗。在中位随访时间34.6个月[四分位距：14.2, 75.9]期间，与单纯免疫治疗相比，转移灶切除术显著改善患者生存。在调整后的Cox比例风险模型中，转移灶切除术与联合治疗组间未观察到生存差异。结论：经风险因素校正后的统计模型显示，与免疫治疗相比，转移灶切除术仍具有显著的生存优势。在肺转移灶切除术基础上联合免疫治疗未能进一步提升生存获益。本研究结果支持手术治疗在肺转移性黑色素瘤患者中的临床价值。
肿瘤(癌症)患者之家