Metastasectomy for distant metastatic melanoma: analysis of data from the first multicenter selective lymphadenectomy trial (MSLT-I)

Howard, J. Harrison, Thompson, John F., Mozzillo, Nicola, Nieweg, Omgo E., Hoekstra, Harald J., Roses, Daniel F., Sondak, Vernon K., Reintgen, Douglas S., Kashani-Sabet, Mohammed, Karakousis, Constantine P., Coventry, Brendon J., Kraybill, William G., Smithers, B. Mark, Elashoff, Robert, Stern, Stacey L., Cochran, Alistair J., Faries, Mark B. and Morton, Donald L. (2012) Metastasectomy for distant metastatic melanoma: analysis of data from the first multicenter selective lymphadenectomy trial (MSLT-I). Annals of Surgical Oncology, 19 8: 2547-2555. doi:10.1245/s10434-012-2398-z

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Author Howard, J. Harrison
Thompson, John F.
Mozzillo, Nicola
Nieweg, Omgo E.
Hoekstra, Harald J.
Roses, Daniel F.
Sondak, Vernon K.
Reintgen, Douglas S.
Kashani-Sabet, Mohammed
Karakousis, Constantine P.
Coventry, Brendon J.
Kraybill, William G.
Smithers, B. Mark
Elashoff, Robert
Stern, Stacey L.
Cochran, Alistair J.
Faries, Mark B.
Morton, Donald L.
Title Metastasectomy for distant metastatic melanoma: analysis of data from the first multicenter selective lymphadenectomy trial (MSLT-I)
Journal name Annals of Surgical Oncology   Check publisher's open access policy
ISSN 1068-9265
Publication date 2012-08
Sub-type Article (original research)
DOI 10.1245/s10434-012-2398-z
Volume 19
Issue 8
Start page 2547
End page 2555
Total pages 9
Place of publication New York, United States
Publisher Springer New York LLC
Collection year 2013
Language eng
Formatted abstract
Background. For stage IV melanoma, systemic medical therapy (SMT) is used most frequently; surgery is considered an adjunct in selected patients. We retrospectively compared survival after surgery with or without SMT versus SMT alone for melanoma patients developing distant metastases while enrolled in the first Multicenter Selective Lymphadenectomy Trial.
Methods. Patients were randomized to wide excision and sentinel node biopsy, or wide excision and nodal observation. We evaluated recurrence site, therapy (selected by treating clinician), and survival after stage IV diagnosis.
Results. Of 291 patients with complete data for stage IV recurrence, 161 (55 %) underwent surgery with or without SMT. Median survival was 15.8 versus 6.9 months, and 4-year survival was 20.8 versus 7.0 % for patients receiving surgery with or without SMT versus SMT alone (p < 0.0001; hazard ratio 0.406). Surgery with or without SMT conferred a survival advantage for patients with M1a (median > 60 months vs. 12.4 months; 4-year survival 69.3 % vs. 0; p = 0.0106), M1b (median 17.9 vs. 9.1 months; 4-year survival 24.1 vs. 14.3 %; p = 0.1143), and M1c (median 15.0 vs. 6.3 months; 4-year survival 10.5 vs. 4.6 %; p = 0.0001) disease. Patients with multiple metastases treated surgically had a survival advantage, and number of operations did not reduce survival in the 67 patients (42 %) who had multiple surgeries for distant melanoma.
Conclusions. Our findings suggest that over half of stage IV patients are candidates for resection and exhibit improved survival over patients receiving SMT alone, regardless of site and number of metastases. We have begun a multicenter randomized phase III trial comparing surgery versus SMT as initial treatment for resectable distant melanoma.

Keyword Circulating tumor cells
Malignant melanoma
Gastrointestinal tract
Surgical resection
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 37 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 40 times in Scopus Article | Citations
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