Surgery for Melanoma Liver Mets Can Prolong Survival

Megan Brooks

July 03, 2014

Patients who can undergo complete surgical treatment of melanoma liver metastases should consider this option, say oncologists from California.

In their experience, hepatic resection for metastatic melanoma significantly improves survival over medical treatment alone, they report in the July issue of the Journal of the American College of Surgeons.

"One of the take-home messages of the study is that surgery still can play a role in the treatment of patients with metastatic melanoma, even in the era of more effective medical therapies," said researcher Mark Faries, MD, FACS, director of the melanoma research program at the John Wayne Cancer Institute in Santa Monica, California.

"In fact, there may be an increasing role, particularly among patients who have had a response or disease stabilization on systemic treatment," he told Medscape Medical News.

Melanoma liver metastasis is most often fatal; median overall survival is 4 to 6 months. However, advances in imaging and surgical techniques, along with more effective systemic therapies, have opened the door to more patients being candidates for surgery, the researchers point out.

"Ideal candidates are those who have slow growth of their tumors [due to either the natural growth rate of the tumor or positive effects of medical therapy], and those whose disease can be entirely removed or ablated," Dr. Faries explained.

He and his colleagues looked back at the medical records of patients treated for melanoma liver metastases at their center since 1991. "We've been proponents of metastasectomy for a long time and wanted to know how our patients who had been treated surgically for liver metastases had done," Dr. Faries said in a statement.

In the cohort of 1078 patients, 58 (5.4%) underwent surgery (with or without ablation).

Median overall survival was more than 3 times better with surgery than without surgery (24.8 vs 8.0 months; P < .001). Five-year overall survival was also better with surgery (30.0% vs 6.6%; P < .001).

Patients who had their metastatic disease stabilized with systemic therapy prior to surgery did better than those who did not. On multivariate analysis of surgical patients, predictors of overall survival were completeness of surgical therapy (hazard ratio [HR], 3.4; 95% confidence interval [CI], 1.4 - 8.1; P = .007) and stabilization before surgery (HR, 0.38; 95% CI, 0.19 - 0.78; P = .008).

"The advent of more effective systemic therapy in melanoma may substantially increase the fraction of patients who are eligible for surgical intervention, and this combination of treatment modalities should be considered whenever it is feasible in the context of a multidisciplinary team," Dr. Faries and colleagues conclude.

This study was supported by the National Cancer Institute, the Dr. Miriam & Sheldon G. Adelson Medical Research Foundation, the Borstein Family Foundation, the California Oncology Research Institute, and the John Wayne Cancer Institute Auxiliary. The authors have disclosed no relevant financial relationships.

J Am Coll Surg. 2014;219:62-69. Abstract

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