393. Hepatic resection for metastatic melanoma in the Netherlands – Survival and prognostic factors

Abstract

Patients with hepatic metastases of melanoma have a very poor prognosis, with a median overall survival of less than 6 months. There are several small heterogeneous studies that have shown an association with prolonged survival in those patients treated with hepatic resection, but the role of surgery remains unclear. We evaluated the safety and efficacy of hepatic resection in a population-based study in the Netherlands for patients with metastatic melanoma and assessed the factors that could affect disease-free and overall survival. Patients with hepatic melanoma metastases who underwent potentially curative resection were identified between 1994 until 2010 using the PALGA database, a nation-wide network and registry of histopathology and cytopathology in the Netherlands. They were retrospectively evaluated for clinical and pathological factors with respect to recurrence and survival using Kaplan-Meier curves to assess survival and univariate regression analysis for the assessment of potential prognostic factors. A total of 32 patients were identified in 15 hospitals, 19 men and 13 women. The median age of the patients at the time of hepatic resection was 52 years (range 27-69). Postoperative complications occurred in five patients (15%), without postoperative mortality. The median follow-up was 21 months (range 3-65). The median disease-free survival was 11 months (range 0-57) and the median overall survival was 29 months (range 4-66). Significant prognostic factors for overall survival in univariate analysis were the distribution and number of metastases, as well as the type of hepatic resection (major or minor). Hepatic resection in patients with resectable metastatic melanoma is safe and might be associated with a prolonged survival in a highly selected group of patients.

Metastatic melanoma to the liver: A contemporary and comprehensive review of surgical, systemic, and regional therapeutic options

“…These observations concur with a recent meta‐analysis of 5 studies which reported a significant improvement in overall survival following surgery versus nonoperative management in patients with ocular or cutaneous metastatic melanoma (hazard ratio [HR] = 0.32, 95% confidence interval [CI] = 0.22‐0.46; P < .001) . Prolonged overall survival times were also reported in several noncomparative studies of hepatic resection in patients with ocular or cutaneous melanoma (range, 19‐39 months) (Table ) . Five‐year overall survival rates ranged from 0% to 42% following hepatic resection, although most studies reported rates in excess of 20% (Table ) …”

“…In 2 large patient series, 60‐day mortality rates were 1.9% and 2.3% . Postoperative complication rates of 15% to 20% were documented in other studies …”

“…Prolonged overall survival times were also reported in several noncomparative studies of hepatic resection in patients with ocular or cutaneous melanoma (range, 19‐39 months) (Table ) . Five‐year overall survival rates ranged from 0% to 42% following hepatic resection, although most studies reported rates in excess of 20% (Table ) …”

“… Time from development of hepatic metastases, metastases treatment, or hepatic resection to death. No definition was provided in the remaining studies.…”

“…For example, Rivoire et al found that R0 surgery significantly influenced outcome compared with R2 surgery or chemotherapy/best supportive care ( P = .0002); median overall survival was 25 months following R0 resection, 16 months after R2 resection, and 11 months with nonsurgical care. Other significant positive prognostic indicators included low numbers of lesions, long disease‐free interval, and limited disease distribution (ie, unilobar) …”