title: Improved survival with pulmonary metastasectomy: an analysis of 1720 patients with pulmonary metastatic melanoma.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Rebecca P
authors.initials: RP
authors.lastname: Petersen
authors.forename: Steven I
authors.initials: SI
authors.lastname: Hanish
authors.forename: John C
authors.initials: JC
authors.lastname: Haney
authors.forename: Charles C
authors.initials: CC
authors.lastname: Miller
authors.forename: William R
authors.initials: WR
authors.lastname: Burfeind
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.forename: Hilliard F
authors.initials: HF
authors.lastname: Seigler
authors.forename: Walter
authors.initials: W
authors.lastname: Wolfe
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D012878:Skin Neoplasms / Q000473:pathology*; D015996:Survival Rate