Improved survival with pulmonary metastasectomy

An analysis of 1720 patients with pulmonary metastatic melanoma

Rebecca P. Petersen, Steven I. Hanish, John C. Haney, Charles C. Miller, William R. Burfeind, Douglas Tyler, Hilliard F. Seigler, Walter Wolfe, Thomas A. D'Amico, David H. Harpole

Research output: Contribution to journalArticle

122 Citations (Scopus)

Abstract

Objectives: The outcomes of patients with metastatic melanoma are poor. Although prognostic models have been developed to predict the occurrence of pulmonary metastasis from cutaneous melanoma, few data exist to define the outcomes of these patients once metastasis has occurred. The objective of this study was to discriminate predictors of survival for patients with pulmonary metastatic melanoma. Methods: We found 1720 patients with pulmonary metastasis listed in a prospective comprehensive cancer center database of 14,057 consecutive patients with melanoma (Jan 1, 1970-June 1, 2004). Demographic and histopathologic data, time and location of recurrences, number of pulmonary nodules, and subsequent therapies were collected. Univariate and multivariate Cox proportional hazards models were used to identify predictors of survival for patients with pulmonary metastatic melanoma. Results: The median survival was 7.3 months after development of pulmonary metastasis. Significant predictors of survival from the multivariate model included nodular histologic type (P = .033), disease-free interval (P < .001), number of pulmonary metastases (P = .012), presence of extrathoracic metastasis (P < .001), and performance of pulmonary metastasectomy (P < .001). Interactions were identified between metastasectomy and disease-free interval and presence of extrathoracic metastasis. Surgery was associated with a survival advantage of 12 months for patients with a disease-free interval longer than 5 years (19 vs 7 months, P < .01) and of 10 months for patients without extrathoracic metastasis (18 vs 8 months, P < .01). Conclusions: When all other identified risk factors were controlled for mathematically, metastasectomy maintained a significant survival advantage for patients with pulmonary metastatic melanoma. These data support the role of surgery for a select subset of patients with pulmonary metastasis.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
Volume133
Issue number1
DOIs
StatePublished - Jan 2007
Externally publishedYes

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Metastasectomy
Melanoma
Lung
Neoplasm Metastasis
Survival
Proportional Hazards Models
Demography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Improved survival with pulmonary metastasectomy : An analysis of 1720 patients with pulmonary metastatic melanoma. / Petersen, Rebecca P.; Hanish, Steven I.; Haney, John C.; Miller, Charles C.; Burfeind, William R.; Tyler, Douglas; Seigler, Hilliard F.; Wolfe, Walter; D'Amico, Thomas A.; Harpole, David H.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 133, No. 1, 01.2007.

Research output: Contribution to journalArticle

Petersen, RP, Hanish, SI, Haney, JC, Miller, CC, Burfeind, WR, Tyler, D, Seigler, HF, Wolfe, W, D'Amico, TA & Harpole, DH 2007, 'Improved survival with pulmonary metastasectomy: An analysis of 1720 patients with pulmonary metastatic melanoma', Journal of Thoracic and Cardiovascular Surgery, vol. 133, no. 1. https://doi.org/10.1016/j.jtcvs.2006.08.065
Petersen, Rebecca P. ; Hanish, Steven I. ; Haney, John C. ; Miller, Charles C. ; Burfeind, William R. ; Tyler, Douglas ; Seigler, Hilliard F. ; Wolfe, Walter ; D'Amico, Thomas A. ; Harpole, David H. / Improved survival with pulmonary metastasectomy : An analysis of 1720 patients with pulmonary metastatic melanoma. In: Journal of Thoracic and Cardiovascular Surgery. 2007 ; Vol. 133, No. 1.
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abstract = "Objectives: The outcomes of patients with metastatic melanoma are poor. Although prognostic models have been developed to predict the occurrence of pulmonary metastasis from cutaneous melanoma, few data exist to define the outcomes of these patients once metastasis has occurred. The objective of this study was to discriminate predictors of survival for patients with pulmonary metastatic melanoma. Methods: We found 1720 patients with pulmonary metastasis listed in a prospective comprehensive cancer center database of 14,057 consecutive patients with melanoma (Jan 1, 1970-June 1, 2004). Demographic and histopathologic data, time and location of recurrences, number of pulmonary nodules, and subsequent therapies were collected. Univariate and multivariate Cox proportional hazards models were used to identify predictors of survival for patients with pulmonary metastatic melanoma. Results: The median survival was 7.3 months after development of pulmonary metastasis. Significant predictors of survival from the multivariate model included nodular histologic type (P = .033), disease-free interval (P < .001), number of pulmonary metastases (P = .012), presence of extrathoracic metastasis (P < .001), and performance of pulmonary metastasectomy (P < .001). Interactions were identified between metastasectomy and disease-free interval and presence of extrathoracic metastasis. Surgery was associated with a survival advantage of 12 months for patients with a disease-free interval longer than 5 years (19 vs 7 months, P < .01) and of 10 months for patients without extrathoracic metastasis (18 vs 8 months, P < .01). Conclusions: When all other identified risk factors were controlled for mathematically, metastasectomy maintained a significant survival advantage for patients with pulmonary metastatic melanoma. These data support the role of surgery for a select subset of patients with pulmonary metastasis.",
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T2 - An analysis of 1720 patients with pulmonary metastatic melanoma

AU - Petersen, Rebecca P.

AU - Hanish, Steven I.

AU - Haney, John C.

AU - Miller, Charles C.

AU - Burfeind, William R.

AU - Tyler, Douglas

AU - Seigler, Hilliard F.

AU - Wolfe, Walter

AU - D'Amico, Thomas A.

AU - Harpole, David H.

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N2 - Objectives: The outcomes of patients with metastatic melanoma are poor. Although prognostic models have been developed to predict the occurrence of pulmonary metastasis from cutaneous melanoma, few data exist to define the outcomes of these patients once metastasis has occurred. The objective of this study was to discriminate predictors of survival for patients with pulmonary metastatic melanoma. Methods: We found 1720 patients with pulmonary metastasis listed in a prospective comprehensive cancer center database of 14,057 consecutive patients with melanoma (Jan 1, 1970-June 1, 2004). Demographic and histopathologic data, time and location of recurrences, number of pulmonary nodules, and subsequent therapies were collected. Univariate and multivariate Cox proportional hazards models were used to identify predictors of survival for patients with pulmonary metastatic melanoma. Results: The median survival was 7.3 months after development of pulmonary metastasis. Significant predictors of survival from the multivariate model included nodular histologic type (P = .033), disease-free interval (P < .001), number of pulmonary metastases (P = .012), presence of extrathoracic metastasis (P < .001), and performance of pulmonary metastasectomy (P < .001). Interactions were identified between metastasectomy and disease-free interval and presence of extrathoracic metastasis. Surgery was associated with a survival advantage of 12 months for patients with a disease-free interval longer than 5 years (19 vs 7 months, P < .01) and of 10 months for patients without extrathoracic metastasis (18 vs 8 months, P < .01). Conclusions: When all other identified risk factors were controlled for mathematically, metastasectomy maintained a significant survival advantage for patients with pulmonary metastatic melanoma. These data support the role of surgery for a select subset of patients with pulmonary metastasis.

AB - Objectives: The outcomes of patients with metastatic melanoma are poor. Although prognostic models have been developed to predict the occurrence of pulmonary metastasis from cutaneous melanoma, few data exist to define the outcomes of these patients once metastasis has occurred. The objective of this study was to discriminate predictors of survival for patients with pulmonary metastatic melanoma. Methods: We found 1720 patients with pulmonary metastasis listed in a prospective comprehensive cancer center database of 14,057 consecutive patients with melanoma (Jan 1, 1970-June 1, 2004). Demographic and histopathologic data, time and location of recurrences, number of pulmonary nodules, and subsequent therapies were collected. Univariate and multivariate Cox proportional hazards models were used to identify predictors of survival for patients with pulmonary metastatic melanoma. Results: The median survival was 7.3 months after development of pulmonary metastasis. Significant predictors of survival from the multivariate model included nodular histologic type (P = .033), disease-free interval (P < .001), number of pulmonary metastases (P = .012), presence of extrathoracic metastasis (P < .001), and performance of pulmonary metastasectomy (P < .001). Interactions were identified between metastasectomy and disease-free interval and presence of extrathoracic metastasis. Surgery was associated with a survival advantage of 12 months for patients with a disease-free interval longer than 5 years (19 vs 7 months, P < .01) and of 10 months for patients without extrathoracic metastasis (18 vs 8 months, P < .01). Conclusions: When all other identified risk factors were controlled for mathematically, metastasectomy maintained a significant survival advantage for patients with pulmonary metastatic melanoma. These data support the role of surgery for a select subset of patients with pulmonary metastasis.

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