Surgical management of melanoma lung metastasis: an analysis of survival outcomes in 292 consecutive patients.

ABSTRACT

BACKGROUND: The role of surgical resection of melanoma lung metastases (MLM) remains controversial. Some authorities advocate an aggressive surgical approach, while others recommend a conservative strategy. This study sought to identify the clinicopathologic and predictors of outcome after surgical management of MLM in a large series of melanoma patients from a single institution. METHODS: All patients undergoing surgical management of MLM between November 1984 and April 2010 were identified and predictors of outcome analyzed. RESULTS: Of the 292 patients eligible for the study, 112 (38%) had previously undergone surgery for nonpulmonary recurrences. Four patients (1%) died within 30 days of surgery for MLM. The median progression-free survival time was 10 months. The median overall survival and 3- and 5-year survival were 23 months [95% confidence interval (CI) 17­30], 41 and 34%, respectively. Metastasis size >2 cm [hazard ratio (HR) 1.4, 95% CI 1.0­1.8, P = 0.03, HR 1.6, 95% CI 1.2­2.2; P = 0.002] and positive surgical margin (HR 1.5, 95% CI 1.2­1.9, P < 0.001; HR 1.4, 95% CI 1.1­1.7, P = 0.003) were independently associated with poorer progression-free survival and overall survival, respectively. The presence of more than one metastasis (HR 1.4, 95% CI 1.1­1.7, P = 0.013) was independently associated with poorer overall survival. CONCLUSIONS: The results support the role of pulmonary metastasectomy in selected patients with MLM. Patients with small (<2 cm) and solitary tumors that can be completely resected with a negative margin are most likely to experience prolonged survival.