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Rebecca P. Petersen
William R. Burfeind, Jr
Walter Wolfe
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David H. Harpole, Jr
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J Thorac Cardiovasc Surg 2007;133:104-110
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Improved survival with pulmonary metastasectomy: An analysis of 1720 patients with pulmonary metastatic melanoma

Rebecca P. Petersen, MD, MSca, Steven I. Hanish, MDa, John C. Haney, MDa, Charles C. Miller, III, PhDb, William R. Burfeind, Jr, MDa, Douglas S. Tyler, MDa, Hilliard F. Seigler, MDa, Walter Wolfe, MDa, Thomas A. D’Amico, MDa, David H. Harpole, Jr, MDa,*

a Department of Surgery, Duke University Medical Center, Durham, NC, Texas
b Department of Cardiothoracic and Vascular Surgery, University of Texas–Houston Health Science Center, Houston, Texas.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29–May 3, 2006.

Received for publication April 28, 2006; revisions received July 18, 2006; accepted for publication August 7, 2006.

* Address for reprints: David H. Harpole, Jr, MD, Department of Surgery, Duke University Medical Center, Box 3617, Durham, NC 27710. (Email: harpo002{at}mc.duke.edu).

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.

Abbreviations and Acronyms CT = computed tomography; PET = positron emission tomography


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