title: Association of Surgical Treatment, Systemic Therapy, and Survival in Patients With Abdominal Visceral Melanoma Metastases, 1965-2014: Relevance of Surgical Cure in the Era of Modern Systemic Therapy.
abstract: Systemic therapy for metastatic melanoma has evolved rapidly during the last decade, and patient treatment has become more complex.
  
  
  
  To evaluate the survival benefit achieved through surgical resection of melanoma metastatic to the abdominal viscera in patients treated in the modern treatment environment.
  
  
  
  This retrospective review of the institutional melanoma database from the John Wayne Cancer Institute at Providence St Johns Health Center, a tertiary-level melanoma referral center, included 1623 patients with melanoma diagnosed as having potentially resectable abdominal metastases before (1969-2003) and after (2004-2014) advances in systemic therapy.
  
  
  
  Overall survival (OS).
  
  
  
  Of the 1623 patients identified in the database with abdominal melanoma metastases, 1097 were men (67.6%), and the mean (SD) age was 54.6 (14.6) years. Of the patients with metastatic melanoma, 1623 (320 [19.7%] in the 2004-2014 period) had abdominal metastases, including 336 (20.7%) with metastases in the gastrointestinal tract, 697 (42.9%) in the liver, 138 (8.5%) in the adrenal glands, 38 (2.3%) in the pancreas, 109 (6.7%) in the spleen, and 305 (18.8%) with multiple sites. Median OS was superior in surgical (n = 392; 18.0 months) vs nonsurgical (n = 1231; 7.0 months) patients (P < .001). The most favorable 1-year and 2-year OS was seen after surgery for gastrointestinal tract (52% and 41%) and liver (51% and 38%) metastases, respectively. Multivariable analysis found increasing age (hazard ratio [HR], 1.01; 95% CI, 1.00-1.01; P = .02) and the presence of ulceration (HR, 1.21; 95% CI, 1.01-1.45; P = .04) were associated with a worse OS. Alternatively, treatment with metastasectomy (HR, 0.59; 95% CI, 0.46-0.74; P < .001) and metastases involving the gastrointestinal tract (HR, 0.65; 95% CI, 0.48-0.87; P = .004) were associated with a better OS. The systemic treatment era did not significantly affect outcomes (HR, 0.82; 95% CI, 0.67-1.02; P = .15). Overall, patients with gastrointestinal tract metastases undergoing complete, curative resection derived the greatest benefit, with a median OS of 64 months.
  
  
  
  To our knowledge, this series is the largest single-institution experience with abdominal melanoma metastases, demonstrating that surgical resection remains an important treatment consideration even in the systemic treatment era.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Hofstra Northwell School of Medicine, Uniondale, New York.
authors.forename: Gary B
authors.initials: GB
authors.lastname: Deutsch
authors.affiliation: Valley Health Cancer Center, Winchester Medical Center, Winchester, Virginia.
authors.forename: Devin C
authors.initials: DC
authors.lastname: Flaherty
authors.affiliation: Roper St Francis Physician Partners, Charleston, South Carolina.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Kirchoff
authors.affiliation: David Geffen School of Medicine at University of California, Los Angeles.
authors.forename: Mariel
authors.initials: M
authors.lastname: Bailey
authors.affiliation: University of Queensland School of Medicine, Ochsner Clinical School, Brisbane, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Vitug
authors.affiliation: John Wayne Cancer Institute at Providence St Johns Health Center, Santa Monica, California.
authors.forename: Leland J
authors.initials: LJ
authors.lastname: Foshag
authors.affiliation: John Wayne Cancer Institute at Providence St Johns Health Center, Santa Monica, California.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Faries
authors.affiliation: David Geffen School of Medicine at University of California, Los Angeles6John Wayne Cancer Institute at Providence St Johns Health Center, Santa Monica, California7California Oncology Research Institute, Los Angeles, California.
authors.forename: Anton J
authors.initials: AJ
authors.lastname: Bilchik
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D004067:Digestive System Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D006801:Humans; D000074324:Ipilimumab; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D059146:Metastasectomy; D008875:Middle Aged; D000077594:Nivolumab; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D012189:Retrospective Studies; D013160:Splenic Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D015996:Survival Rate
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000074324:Ipilimumab; D000077594:Nivolumab; C582435:pembrolizumab