Treatment Strategies and Survival Trends for Anorectal Melanoma: Is it Time for a Change?
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
pubmed:
5
3
2019
medline:
19
11
2019
entrez:
5
3
2019
Statut:
ppublish
Résumé
Immunotherapy advances for the treatment of cutaneous melanoma question its efficacy in treating anorectal mucosal melanoma (ARMM). We aimed to identify the prevalence, current management, and overall survival (OS) for ARMM. Review of patients with ARMM from 2004 to 2015 National Cancer Database. Factors associated with immunotherapy were identified using multivariable logistic regression. The primary outcome was 2- and 5-year OS. Subgroup analysis by treatment type was performed. A total of 1331 patients were identified with a significant increase in prevalence (2004: 6.99%, 2015: 10.53%). ARMM patients were older, white, on Medicare, and from the South. The most common treatment was surgery (48.77%), followed by surgery + radiation (11.75%), surgery + immunotherapy (8.68%), and surgery + chemotherapy (8.68%). 16.93% of patients received immunotherapy, with utilization increasing (7.24%: 2004, 21.27%: 2015, p < 0.001). Patients who received immunotherapy had a significantly better 2-year OS (42.47% vs. 49.21%, p < 0.001), and other therapies did not reveal a significant difference. Adjusted analysis showed no difference in 2- and 5-year OS based on therapy type. The prevalence of ARMM has increased. The use of immunotherapy has increased substantially. Some survival benefit with the administration of immunotherapy may exist that has yet to be revealed. A more aggressive treatment paradigm is warranted.
Sections du résumé
BACKGROUND
Immunotherapy advances for the treatment of cutaneous melanoma question its efficacy in treating anorectal mucosal melanoma (ARMM). We aimed to identify the prevalence, current management, and overall survival (OS) for ARMM.
METHODS
Review of patients with ARMM from 2004 to 2015 National Cancer Database. Factors associated with immunotherapy were identified using multivariable logistic regression. The primary outcome was 2- and 5-year OS. Subgroup analysis by treatment type was performed.
RESULTS
A total of 1331 patients were identified with a significant increase in prevalence (2004: 6.99%, 2015: 10.53%). ARMM patients were older, white, on Medicare, and from the South. The most common treatment was surgery (48.77%), followed by surgery + radiation (11.75%), surgery + immunotherapy (8.68%), and surgery + chemotherapy (8.68%). 16.93% of patients received immunotherapy, with utilization increasing (7.24%: 2004, 21.27%: 2015, p < 0.001). Patients who received immunotherapy had a significantly better 2-year OS (42.47% vs. 49.21%, p < 0.001), and other therapies did not reveal a significant difference. Adjusted analysis showed no difference in 2- and 5-year OS based on therapy type.
CONCLUSION
The prevalence of ARMM has increased. The use of immunotherapy has increased substantially. Some survival benefit with the administration of immunotherapy may exist that has yet to be revealed. A more aggressive treatment paradigm is warranted.
Identifiants
pubmed: 30830243
doi: 10.1007/s00268-019-04960-w
pii: 10.1007/s00268-019-04960-w
doi:
Substances chimiques
Antineoplastic Agents, Immunological
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1809-1819Références
JAMA Surg. 2018 Sep 1;153(9):841-849
pubmed: 29926104
Nat Clin Pract Oncol. 2008 Dec;5(12):737-40
pubmed: 18936790
Br J Surg. 2004 Sep;91(9):1183-7
pubmed: 15449271
Front Immunol. 2017 Dec 08;8:1617
pubmed: 29276510
Br J Cancer. 2008 Sep 2;99(5):734-40
pubmed: 18728664
J Cancer Res Clin Oncol. 2016 Dec;142(12):2569-2575
pubmed: 27620741
Can J Surg. 2003 Oct;46(5):345-9
pubmed: 14577706
Dermatol Surg. 2016 Jan;42(1):94-9
pubmed: 26655698
Dis Colon Rectum. 1995 Feb;38(2):146-51
pubmed: 7851168
Pigment Cell Melanoma Res. 2008 Aug;21(4):492-3
pubmed: 18510589
Cancer. 2005 Mar 1;103(5):1000-7
pubmed: 15651058
Colorectal Dis. 2017 Feb;19(2):158-164
pubmed: 27317493
Gastroenterology. 1993 Jan;104(1):174-8
pubmed: 8419240
Pathol Oncol Res. 2018 Apr;24(2):401-406
pubmed: 28567600
N Engl J Med. 2010 Aug 19;363(8):711-23
pubmed: 20525992
J Eur Acad Dermatol Venereol. 2011 Dec;25(12):1444-9
pubmed: 21995584
Melanoma Res. 2009 Feb;19(1):58-60
pubmed: 19430407
Oncotarget. 2018 Jan 2;9(9):8785-8800
pubmed: 29492238
Clin Colon Rectal Surg. 2009 May;22(2):120-6
pubmed: 20436837
J Natl Compr Canc Netw. 2012 Mar;10(3):345-56
pubmed: 22393195
Cancer. 2010 Apr 1;116(7):1767-75
pubmed: 20143434
Lancet Oncol. 2005 Jun;6(6):438-9
pubmed: 15925823
Int J Surg Case Rep. 2017;31:188-192
pubmed: 28171845
Ann Surg Oncol. 2010 Jan;17(1):40-4
pubmed: 19774417
Dis Colon Rectum. 2010 Apr;53(4):402-8
pubmed: 20305438
Urol Oncol. 2013 Nov;31(8):1800-5
pubmed: 22658883
Cancer Immunol Res. 2014 Jan;2(1):15-8
pubmed: 24778161
Dis Colon Rectum. 2011 May;54(5):638-44
pubmed: 21471767
Am Surg. 2016 Jan;82(1):1-5
pubmed: 26802836
Colorectal Dis. 2008 Jul;10(6):612-5
pubmed: 17944970
Cancer. 1998 Oct 15;83(8):1664-78
pubmed: 9781962
N Engl J Med. 2005 Nov 17;353(20):2135-47
pubmed: 16291983
Br J Cancer. 2005 Apr 25;92(8):1398-405
pubmed: 15846297
J Clin Oncol. 2008 Apr 20;26(12):2046-51
pubmed: 18421059
Cancer. 2011 May 15;117(10):2202-8
pubmed: 21523734
Front Immunol. 2018 Apr 19;9:797
pubmed: 29725330
Mol Cancer Ther. 2009 Aug;8(8):2079-85
pubmed: 19671763
JAMA. 2011 Jun 8;305(22):2327-34
pubmed: 21642685
Ann Surg. 2006 Dec;244(6):1012-7
pubmed: 17122627
J Am Coll Surg. 2003 Feb;196(2):206-11
pubmed: 12595048