Imaging Intensity and Survival Outcomes in High-Risk Resected Melanoma Treated by Systemic Therapy at Recurrence
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ORIGINAL ARTICLE – MELANOMA
Imaging Intensity and Survival Outcomes in High-Risk Resected Melanoma Treated by Systemic Therapy at Recurrence Andrea Marie Ibrahim, MSc1, Melanie Le May, MD, MSc2, Dominick Bosse´, MD, MSc, MPH, FRCPC3, Horia Marginean, MD, MS1, Xinni Song, MD, FRCPC3, Carolyn Nessim, MD, MSc, FRCSC, FACS4, and Michael Ong, MD, FRCPC3 Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; 2Division of Internal Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; 3Division of Medical Oncology, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; 4Division of General Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada 1
ABSTRACT Background. Intensive imaging in melanoma remains controversial because its survival impact is unknown. We investigated the impact of imaging intensity on the rates of asymptomatic surveillance-detected recurrence (ASDR) and subsequent treatment outcomes in patients with access to immune checkpoint inhibitors (ICIs) and targeted therapy (TT). Methods. Patients with resected malignant melanoma undergoing imaging surveillance at a single center between 2006 and 2016 were identified. Surveillance and recurrence characteristics (imaging, symptom, treatment, and survival data) were retrospectively collected. Univariate (t test, Chi square test) and multivariate Cox regression analyses were conducted. Results. Of 353 high-risk melanoma patients (stage IIB, 24%; IIC, 19%; IIIA, 27%; IIIB, 16%; IIIC, 14%), 71 (45%) had ASDR and 88 (55%) had symptomatic recurrence (SR). Shorter imaging intervals identified more ASDR (57%, 0–6 months; 34%, 6–12 months; 33%, [ 12 months; p = 0.03). ASDR had better prognostic factors than SR [fewer than three metastatic sites (43 vs.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08407-8) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 28 October 2019 M. Ong, MD, FRCPC e-mail: [email protected]
21%, p = 0.003), normal lactate dehydrogenase (LDH; 53 vs. 38%, p = 0.09), brain metastases (11 vs. 40%, p \ 0.001)] and received more systemic treatment (72 vs. 49%, p = 0.003; ICIs 55 vs. 31%, p = 0.002; TT 8 vs. 13%, p = 0.41). ASDR had better survival outcomes on ICI treatment (2-year OS, 56 vs. 31%, p \ 0.001). Median OS from surveillance start was 39.6 vs. 22.8 months (p \ 0.001). ASDR was independently associated with survival (hazard ratio 0.47, 95% confidence interval 0.29–0.78, p = 0.003), adjusting for stage, sex, age, disease burden, LDH, era of recurrence, brain metastases, and ICI/ TT treatment. Conclusions. These real-world data support further study on intensified imaging surveillance protocols for high-risk resected melanoma, as ASDR was associated with superior survival outcomes from ICI therapy.
Malignant cutaneous melanoma carries a high propensity for distant spread even at the earliest stages of detection.1 Appropriate imaging surveilla
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