Melanoma
Thinzar M. Lwin, MD, MS
Fellow
Dana Farber Cancer Institute
West Roxbury, Massachusetts, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
The utilization of surgical resection in stage 4 melanoma in the current immunotherapy era is unclear. We hypothesized that surgical resection of metastatic disease for stage 4 melanoma is more common when immunotherapy is used.
Methods:
The National Cancer Database (NCDB) from 2012-2017 was queried to identify patients with stage 4 melanoma who received surgical resection of distant metastatic disease and immunotherapy. Patient demographics, facility-level characteristics, and the use of immunotherapy were compared between patients with metastatic melanoma who received surgery and those who did not receive surgery. Multivariate Poisson regression model adjusting for all potential confounders was used to evaluate the association between receiving immunotherapy and undergoing surgical resection of stage 4 melanoma. Kaplan Meier survival and Cox regression analyses were performed to evaluate association between surgical resection and immunotherapy.
Results:
There were 9,800 patients with stage 4 melanoma, and 2,160 patients (22.0%) underwent surgical resection of distant metastatic disease. Patients who underwent surgery were more likely to be younger (P < 0.001), have private insurance (P < 0.001), have higher median income based on zip code (P=0.008), receive treatment at academic/research programs (P < 0.001), and less likely to receive immunotherapy (33.7% vs 36.6%; P = 0.013). On multivariate analysis, patients who received immunotherapy had a significantly lower likelihood of undergoing surgical resection (RR 0.82, 95% CI 0.75-0.88; P < 0.001). Among patients who received immunotherapy, surgical resection of distant metastatic disease was not associated with a difference in overall survival (Figure 1).
Conclusions:
Among patients with stage IV melanoma, having received immunotherapy was associated with a lower likelihood of undergoing surgical resection of distant metastatic disease in the immunotherapy era. There is inequality in access to surgical resection of metastatic disease. Surgical resection of metastatic disease was not associated with longer overall survival among patients who received immunotherapy.